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A disconnect between disease activity and functional ability already in patients with early rheumatoid arthritis, depending on large joint involvement
  1. Andrea Rubbert-Roth1,
  2. Johannes W G Jacobs2,
  3. Johannes W J Bijlsma2,
  4. Paco M J Welsing2
  1. 1 Medical Clinic I, University of Cologne, Cologne, Germany
  2. 2 Department of Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
  1. Correspondence to Associate Professor Johannes W G Jacobs, Department of Rheumatology & Clinical Immunology, University Medical Center, PO Box 85500, Utrecht, The Netherlands; j.w.g.jacobs{at}

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Current strategies in rheumatoid arthritis (RA) management aim at diagnosing patients and starting disease-modifying antirheumatic drug (DMARD) treatment very early to optimise outcome. International guidelines recommend the initial use of conventional synthetic disease-modifying drugs, especially methotrexate (MTX),1 even though it has recently been demonstrated that early addition of biologics to the therapeutic regimen with MTX can optimise response.2 The prevention of functional deterioration is an important treatment goal from both patient and societal perspectives. Previous studies in patients with early RA,3 and in patients with established RA,4 demonstrated that large joint involvement is strongly associated with functional impairment and with mortality in long-term observational cohorts.5

This post hoc analysis of the U-Act-Early trial was conducted to examine in a cohort of patients with very early RA the impact of large joint involvement (LJI) on disease activity and functional capacity over time. In this trial, 317 patients from 21 Dutch centres were randomised to start treatment with either MTX or …

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  • Contributors All authors provided substantial contributions to the conception or design of the work; the acquisition, analysis or interpretation of data for the work; and drafting the work or revising it critically for important intellectual content. All authors finally approved this version to be published, and all agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. In addition to being accountable for the parts of the work, all authors are able to identify which co-authors are responsible for specific parts of the work. In addition, all authors have confidence in the integrity of the contributions of their co-authors.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Ethics Committee University Medical Center Utrecht.

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