Abstract
IntroductionArthralgia and MRI-detected subclinical inflammation can precede the development of clinically evident rheumatoid arthritis (RA). However, part of the patients presenting with clinically suspect arthralgia (CSA) do not progress to RA. In these ‘non-progressors’, we aimed to study the frequencies of spontaneous improvement of arthralgia and its relation with the course of subclinical inflammation.MethodsBetween April 2012 and April 2015, 241 patients were considered at risk for RA based on the clinical presentation and included in the CSA cohort. One hundred fifty-two patients with complete data on clinical follow-up did not develop clinical arthritis, of which 98 underwent serial 1.5T MRI scans (wrist, MCP2–5, and MTP1–5 joints) at baseline and after 2 years. MRI scans were scored for synovitis, tenosynovitis, and bone marrow oedema (summed: MRI inflammation score). MRI scores were compared to scores of symptom-free persons.ResultsAfter a 2-year follow-up, 33% of the ‘non-progressors’ had complete resolution of symptoms; 67% had no symptom resolution and were diagnosed as persistent CSA (44%), osteoarthritis (10%), and tendinomuscular complaints (13%). With symptom-free controls as a reference, patients without resolution did not have increased MRI scores at any time point. However, patients achieving resolution of symptoms had increased MRI inflammation scores at baseline (4.0 vs. 2.6, p = 0.037), but not after 2 years (3.0 vs. 2.6; p = 0.57), and during follow-up, their MRI inflammation score decreased significantly (p = 0.036).ConclusionsA subgroup of CSA patients that did not progress to RA had spontaneous improvement of symptoms and resolution of subclinical joint inflammation. This time relationship suggests that symptoms and inflammation were causally related in these patients. Further research is needed to identify the mechanisms underlying the resolution of inflammation.
Highlights
Arthralgia and MRI-detected subclinical inflammation can precede the development of clinically evident rheumatoid arthritis (RA)
Most longitudinal studies performed in patients considered at risk for RA focussed on the progression from arthralgia to RA [1, 2], since identification of individuals that will develop RA is a key point from a clinician’s perspective
Patients Between April 2012 and April 2015, 241 patients were included in the clinically suspect arthralgia (CSA) cohort: CSA patients had no clinically evident arthritis, but recent-onset (< 1 year) arthralgia of small joints, that was clinically considered at risk for RA by the rheumatologist at first presentation at the outpatient clinic
Summary
Arthralgia and MRI-detected subclinical inflammation can precede the development of clinically evident rheumatoid arthritis (RA). More than 90% of patients that develop RA had MRI-detected subclinical inflammation in small joints in the symptomatic phase of clinically suspect arthralgia (CSA). There is a group of patients that were considered at risk for RA but over time do not develop RA, meaning that in hindsight, they possibly have not been truly ‘pre-RA’. This subgroup of patients is unexplored, and the course and outcome of joint symptoms and subclinical inflammation in these patients are yet unknown. Despite non-progression, subclinical joint inflammation could be present in (part of) these patients at first presentation and comprehension on the natural course and severity of subclinical inflammation, and its relationship with spontaneous disappearance of arthralgia increases our understanding on spontaneous resolution occurring in patients at risk phases of RA
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