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Large joint involvement at first presentation with RA, an unfavourable feature: results of a large longitudinal study with functioning and DMARD-free sustained remission as outcomes
  1. Leonie E Burgers,
  2. Debbie M Boeters,
  3. Annette HM van der Helm-van Mil
  1. Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Leonie E Burgers, Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; l.e.burgers{at}

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With great interest we read the recently published letter by Rubbert-Roth et al.1 In a post-hoc analysis of the U-Act-Early trial in 317 patients with very early rheumatoid arthritis (RA),2 it was observed that patients with large joint involvement (LJI) at baseline had significantly more disease activity and more functional disability at baseline. In addition, while the disease activity score (DAS) was similar after 2 years of follow-up compared with patients without LJI, the difference in functional disability remained. Furthermore, patients without LJI had a higher chance of achieving drug-free remission. The authors concluded that equal weighting of joints in the DAS is contrasting an unequal impact on physical function.1

The idea of a weighted joint score is not new. A joint index that takes the joint surface into account, thus weighing large joints heavier than small joints, is the Lansbury index.3 It has been reported that this index correlates better with C reactive protein (CRP) than joint …

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  • Contributors LEB drafted and approved the final manuscript and helped with the study design, data acquiring, data analysis and interpretation of the data. DMB helped with the data acquiring, data analysis, interpretation of the data and critically revised and approved the final manuscript. AvdHM designed the study, helped acquire and interpret the data and critically revised and approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval Local Medical Ethical Committee, Leiden University Medical Center.

  • Provenance and peer review Not commissioned; internally peer reviewed.