Extended overview of selected articles
| First author, year publicationref | Study design | Population, Location | N | Age, years mean±SD or median (IQR) | Female (%) | Symptom duration (months) mean ±SD or median (IQR) | Definition symptom onset | Outcome of relevance | Adjustment factors | Relevant results |
|---|---|---|---|---|---|---|---|---|---|---|
| Bosello, 201112 | OC | 1987+ RA, Italy | 121 | 53.6±13.3 | 76 | 5.7±3.5 | NR | ▸ Radiographic joint damage (defined ≥1 unit increase in of SHS/Larsen erosions score) after 1 year FU ▸ ACR remission | ▸ Sex, erosive disease, HAQ ▸ Sex, RF, ACPA, ESR, SJC | ▸ Not having ‘VERA’ predictor of erosiveness at 12 months, OR 2.4 (95% CI 1.1 to 5.6) ▸ ‘VERA’ predictor for ACR remission ,OR 5.3 (95% CI 2.1 to 13.0) |
| Dixey, 200413 | OC | 1987+RA, UK (ERAS) | 866 | <45 : 24% 45–60: 40% >60 : 36% | 66 | 6 (4–11) | NR | Radiographic outcome at 3 years (by Larsen score; cut-off median erosions score and the worst quartile | none | Symptom duration (weeks) on radiographic outcome, OR 1.86 (95% CI 1.30 to 2.66) |
| De Rooy, 20109 | OC | 1987+ RA, Netherlands (EAC Leiden) | 676 | 56.4±15.7 | 67.9 | 6.1±5.2 | Onset of joint symptoms reported by the patient | Arthritis persistency (the reverse of DMARD-free sustained remission) | Age, sex, inclusion period (as proxy for treatment strategy) | Symptom duration (weeks) OR 1.011 on arthritis persistency (95% CI 1.002 to 1.019), p=0.012 |
| Gremese, 201214 | OC (3 cohorts combined) | 1987+ and 2010+ RA patients, Italy | 481 | 54.4±12.0 | 74.4 | 6.4±3.3 | NR | DAS-28 (<2.6) remission at 12 months FU | DAS-28, HAQ, ACPA, erosions, DMARDs within 3 months | ‘VERA’ on DAS-28 remission, OR 2.03 (95% CI 1.15 to 3.30) |
| Hodkinson, 201215 | OC | 1987+ RA, South-Africa | 171 | 47.1±12.4 | 81.9 | 11.7±7.1 | NR | Low disease activity (LDA) at 12 months (SDAI≤11) versus moderate/high disease activity (MDA/HDA; SDAI≥11) | None | LDA symptom duration 9.9±6.9 months vs MDA/HDA 11.7±6.8 months. (mean±SD) Not significant (p value unknown). |
| Jansen, 200116 | OC | 1987+ RA, Netherlands | 130 | 65(21–86) | 67 | 3 (0–24) | Onset of persistent pain and swelling reported by the patient | Δ radiographic damage at 1 year (by SHS). | None | Symptom duration was correlated with radiographic progression (p<0.005) |
| Jayakumar, 201217 | OC | 1987+ RA, UK (ERAS) | 704 | 55 (45–64) | 65.6 | 7 (4–12) | NR | Sustained remission DAS-28<1.6 after 5 years FU | Sex, TJC, treatment and many other baseline variables | Symptom duration <6 months OR 3.15 (95% CI 1.03 to 10.0, p=0.046) |
| Kaufmann, 200318 | OC | 1987+ RA, Germany | 54 | 56 (30–38) | 83.3 | <6 months: 27 (50%) | NR | Radiographic progression defined by yearly increase of Larsen score ≥5.8 | Age, sex, RF, HLA-DR4 SE, erosions, ESR and CRP | Symptom duration (>6 months) on severe radiographic progression OR=1.05, p value=0.826 |
| Lukas, 201122 | OC | RA according to the rheumatologist, France (ESPOIR) | 661 | 48.6±12.1 | 77.2 | <3 months 32% >3 months 68% | Onset of swollen joints reported by the patient | Radiographic progression after 1 year of follow-up (by Δ SHS units) | DAS-28, RF, involvement>3joint groups, CRP, ACPA, treatment (propensity score) | Symptom duration <3 months vs >3 months: estimated marginal means 0.8 units (SEM 0.37) versus 1.7 units (SEM 0.19), p=0.033 |
| Mötönnen, 200223 | RCT | 1987+ RA, Finland (FIN-RACo) | 165 | Mean age varied 46–50 years between the arms | 62 | Combination arm: 6 (4–9) Single arm: 7 (4–11) | NR | ACR remission at 2 years FU (fatigue and duration criteria excluded) | age, sex, SE, RF and number of other ACR1987 criteria fulfilled | Estimated proportion of remission in: – The single treatment group for symptom duration 0–4 months ∼36% vs >4 months ∼10%, p=0.010 – The combination treatment group symptom duration 0–4 months ∼43% vs >4 months ∼40%, p=0.83 |
| Nell, 200424 | OC | 1987+ RA, Austria | 40 | 54 (25–80) | 75 | VERA 3 (2–4) LERA 12 (9–30) | NR | ▸ Radiographic progression (Δ Larsen score) ▸ DAS-28 improvement/remission (<2.6) ▸ HAQ improvement All outcomes after 3 years FU | None | ▸ VERA patients had an increase of 3.6±6.5 units compared with an increase of 14.7±9.9 Larsen units in LERA, p<0.05. (mean±SD) ▸ DAS <2.6 was obtained in 50% of VERA and 15% of the LERA patients (p<0.05). ▸ Change in HAQ score: VERA −0.7±0.7 (−78%), LERA −0.4±0.6 (−44%), p<0.05. |
| Pascual-Ramos, 200925 | OC | 1987+ RA, Mexico | 72 | NR | NR | Erosive 4.9±2.9 And non-erosive dise 6.5±1.8 | NR | Joint damage (erosive disease yes/no) at 1 year FU | None | Symptom duration (months) on erosive disease OR 1.16 (95% CI 0.97 to 1.4), p=0.11 |
| Sanmarti, 200327 | OC | 1987+ RA, Spain | 60 | 52.2±15.7 | 78.3 | 9.5±6.5 | NR | Radiographic progression at 1 year (Larsen Score; progression defined as >2 units) | All baseline variables with p<0.15 in univariable analysis | Multivariable; symptom duration n (months) OR 1.15 (95% CI 1.03 to 1.28), p<0.05 |
| Soderlin, 201128 | OC | 1987+ RA, Sweden (BARFOT) | 180 | 58±15 | 68 | 5.8±12 | NR | ▸ 1 year good EULAR response ▸ Mean Δ HAQ change at 1 year | Age, sex, smoking, RF, HAQ, treatment, DAS-28 | ▸ Patients with a good/moderate EULAR response in case of symptom duration <12 weeks 81%, 13–24 weeks 82% and 25–52 weeks 76%, p=0.03. ▸ HAQ and symptom duration: correlation coefficient=0.12, p=0.0001 |
| Van der Linden, 201021 | OC | 1987+ RA, Netherlands (EAC Leiden) | 598 | 56.8±15.8 | 67.7 | 4.2 (2.4–8.1) | Onset of joint symptom reported by the patient | SHS progression over 6 years based on yearly made x-rays | Age, sex, inclusion period (as proxy for treatment strategy) | Patients with symptom duration >12 weeks have a 1.34-fold higher progression ratio than patients with symptom duration <12 weeks, over a period of 6 years (p=0.001) |
| van der Woude, 20099 | OC | 1987+ RA, UK (ERAS) | 895 | 52±13 | 69 | 8.3±6 | NR | DMARD-free sustained remission | All baseline variables with p<010 univariable analysis | ▸ Multivariable; Symptom duration on achieving DMARD-free remission, HR 0.94 (95% CI 0.89 to 0.99), p=0.029 |
| Van der Woude, 201211 | RCT | 1987+ RA, Netherlands (BeSt Trial) | 508 | 54±13.7 | 68 | 5.3 (3.2–12.2) | NR | DMARD-free sustained remission | Age, sex, DAS-44, ACPA | ▸ Symptom duration on achieving DMARD-free sustained remission, OR 0.99 (95% CI 0.98 to 1.00), p=0.099 |
| Weng, 201030 | OC | 1987+ RA, USA and Mexico | 233 | 50±13 | 77 | 5.7 (0.6–15.9) | First appearance of joint symptoms leading to diagnosis of RA | ▸ Annual progression rate by total Sharp over 2 years. ▸ DAS 44<1.6 over 2 years ▸ Change in HAQ over 2 years | None | ‘Early’ patients (<150 days symptom duration) versus ‘late’ patients (>150 days symptom duration at baseline) ▸ Total Sharp, units per year 3.13±6.49 vs 1.69±4.43, p=0.3 ▸ 2 year DAS 44<1.6: 25% vs 25%, NS (p NR) ▸ Δ HAQ −0.61±0.57 vs −0.42±0.68 NS (p NR) |
ACPA, anti-citrullinated protein antibody; ACR, American College of Rheumatology; CRP, C-reactive protein; DAS, Disease activity score; EAC, early arthritis clinic; ERAS, Early Rheumatoid Arthritis Study group; ESR, erythrocyte sedimentation rate; EULAR, European League Against Rheumatism; FU, follow-up; HAQ, Health assessment questionnaire; HDA, high disease activity; LERA, late early rheumatoid arthritis; NS, Not statistically significant Trend: almost statistically significant; NR, not reported; OC, observational cohort; RCT, randomised controlled trial; RF, rheumatoid factor; SHS, Sharp-van der Heijde Score; TJC, tender joint count; VERA, very early rheumatoid arthritis.