Early undifferentiated arthritis in India: a six month follow up study

Abstract

Introduction Amongst patients with Early arthritis (EA) only some progress to Rheumatoid arthritis (RA) while the majority continue to remain undifferentiated or undergo spontaneous remission. Viral illness may be responsible for some of the self limiting forms of EA. This study was undertaken to evaluate the aetiology and course of EA from India. Objectives To evaluate the aetiology of EA and identify factors that predicts disease progression to RA at 6 months. Methods Patients with arthritis of 6 weeks to 6 months duration involving > 2 joints were included with age matched healthy controls. The evaluation included plain radiograph of hands, radionuclide bone scan, ESR, CRP, viral markers (Toxoplasma, Rubella, Cytomegalovirus, Herpes simplex, parvovirus, Dengue, Chikungunya, HIV, Hepatitis B & C) and auto antibodies (Anti CCP, RF and ANA). Patients received weekly injectable steroids for 4 weeks with NSAIDs and were followed up for 6 months. Factors that predicted the development to RA were identified. Results Of the 30 patients assessed, majority went into spontaneous remission (23/30) with six developing RA and one developing spondyloarthropathy at 6 months. A viral aetiology could not be ascribed to development of arthritis. The presence of higher swollen Joint Count, higher CRP, RF and anti CCP antibodies, erosions on plain radiograph and a positive bone scan predicted progression to RA. Conclusions Most of EA (almost 80%) is self limiting. Anti CCP antibodies are highly specific for RA and might aid in predicting development of RA.