Abstract
BackgroundFirst-degree relatives (FDRs) of people with rheumatoid arthritis (RA) have a fourfold increased risk of developing RA. The Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) questionnaire was developed to document symptoms in persons at risk of RA. The aims of this study were (1) to describe symptoms in a cohort of FDRs of patients with RA overall and stratified by seropositivity and elevated CRP and (2) to determine if patient characteristics were associated with symptoms suggestive of RA.MethodsA cross-sectional study of FDRs of patients with RA, in the PREVeNT-RA study, who completed a study questionnaire, provided a blood sample measured for rheumatoid factor, anti-CCP and CRP and completed the SPARRA questionnaire. Moderate/severe symptoms and symmetrical, small and large joint pain were identified and described. Symptoms associated with both seropositivity and elevated CRP were considered suggestive of RA. Logistic regression was used to determine if symptoms suggestive of RA were associated with patient characteristics.ResultsEight hundred seventy participants provided all data, 43 (5%) were seropositive and 122 (14%) had elevated CRP. The most frequently reported symptoms were sleep disturbances (20.3%) and joint pain (17.9%). Symmetrical and small joint pain were 11.3% and 12.8% higher, respectively, in those who were seropositive and 11.5% and 10.7% higher in those with elevated CRP. In the logistic regression model, seropositivity, older age and feeling depressed were associated with increased odds of small and symmetrical joint pain.ConclusionsThis is the first time the SPARRA questionnaire has been applied in FDRs of patients with RA and has demonstrated that the presence of symmetrical and small joint pain in this group may be useful in identifying people at higher risk of developing RA.
Highlights
First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) have a fourfold increased risk of developing RA
713 had not provided a blood sample, 70 had not been sent a SPARRA questionnaire, 317 had not had their blood sample analysed and 947 had not returned the SPARRA questionnaire resulting in 870 people who were eligible for this analysis (Fig. 1)
We found that symmetrical and small joint pain was associated with antibody positivity and higher levels of inflammation in the blood
Summary
First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) have a fourfold increased risk of developing RA. Studies have shown that patients with RA may have circulating autoantibodies 5 or more years prior to developing the disease [2]. Recent studies have investigated whether treatment prior to a clinical diagnosis of RA can prevent disease onset. Results from the PRAIRI (prevention of clinically manifest RA by B cell directed therapy in the earliest phase of disease) study has shown that a single infusion of rituximab in patients who were seropositive (positive for rheumatoid factor (RF) or anticitrullinated protein antibodies (ACPA)) but without clinical synovitis can delay onset of arthritis, though not prevent it [3]. Further studies are ongoing in patients deemed at high risk of developing RA, usually based on the presence of autoantibodies [4]. Identifying people who are at higher risk of developing RA is not straightforward as the aetiology of RA is incompletely understood and involves the accumulation of both genetic and environmental factors [5]
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