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Joint inflammation tends to recur in the same joints during the rheumatoid arthritis disease course
  1. Sascha L Heckert1,
  2. Sytske Anne Bergstra1,
  3. Xanthe M E Matthijssen1,
  4. Yvonne P M Goekoop-Ruiterman2,
  5. Faouzia Fodili3,
  6. Saskia ten Wolde4,
  7. Cornelia F Allaart1,
  8. Tom W J Huizinga1
  1. 1Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  2. 2Rheumatology, HagaZiekenhuis, Den Haag, Zuid-Holland, The Netherlands
  3. 3Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
  4. 4Rheumatology, Spaarne Hospital, Haarlem, Noord-Holland, The Netherlands
  1. Correspondence to Sascha L Heckert, Rheumatology, Leiden University Medical Center, Leiden, Netherlands; s.l.heckert{at}lumc.nl

Abstract

Objectives We investigated whether local joint swelling recurs in the same joints over time in patients with rheumatoid arthritis (RA) who are treated to target.

Methods Patients with newly diagnosed RA participating in the Behandel-Strategieën, “treatment strategies” (BeSt) study (n=508) were followed for median 10 years while receiving Disease Activity Score (DAS) ≤2.4 steered treatment. Every 3 months 68 joints were assessed for the presence of swelling. We evaluated whether baseline local joint swelling was predictive for swelling in the same joint during follow-up using a multilevel mixed-effect logistic regression model. Different strategies were used to account for missing data. A permutation test was performed to assess if joint swelling was better predicted by baseline swelling of the joint itself than by baseline swelling of randomly selected other joints.

Results In 46% of the joints that were swollen at baseline, joint swelling later recurred at least once during follow-up. Joint swelling at baseline was statistically significantly associated with swelling in the same joint during follow-up (OR 2.37, 95% CI 2.30 to 2.43, p<0.001), and also specifically with recurrent swelling in the same joint (OR 1.73, 95% CI 1.37 to 1.59, p<0.001). Local joint swelling was better predicted by baseline swelling of that particular joint than by baseline swelling of other joints (p<0.001).

Conclusion Joint swelling tends to recur locally in the joints swollen at RA onset. This suggests that local factors influence the manifestation of joint inflammation over time.

  • rheumatoid arthritis
  • inflammation
  • synovitis

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Josef S Smolen

  • Presented at Some data were previously presented at the EULAR 2021 Annual European Congress of Rheumatology E-Congress on June 3th 2021 and published in the following congress abstract: Heckert S, Bergstra SA, Matthijssen X, et al. Ann Rheum Dis 80: POS0097 JOINT INFLAMMATION TENDS TO RECUR IN THE SAME JOINTS DURING THE RHEUMATOID ARTHRITIS DISEASE COURSE. 2021;259.

  • Contributors Concept and design: SLH, SAB and CFA. Acquisition of data: YPMG-R, FF, StW, CFA and TWJH. Analysis and interpretation: SLH, SAB, XMEM, CFA and TWJH. Drafting the manuscript: SLH, SAB and CFA. Revising the manuscript critically: all authors. All authors read and approved the final manuscript.

  • Funding The original BeSt study was funded by a research grant from the Dutch College of Health Insurances with additional funding from Schering-Plough BV and Centocor Inc. The authors, not the sponsors, were responsible for the study design, the collection, analyses and interpretation of all data, the writing of this article and the decision to publish.

  • Competing interests The original BeSt study was funded by a research grant from the Dutch College of Health Insurances with additional funding from Schering-Plough BV and Centocor Inc.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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