Outcomes In Early Rheumatoid Arthritis Research Articles

Outcomes associated with early rheumatoid arthritis

Rheumatoid arthritis is a common disease affecting 1% of adults in the UK and western countires. No single outcome measure comprehensively captures the full range of potential outcomes in early rheumatoid arthritis, so a range of measures are needed. This article evaluates the clinical and economic outcomes of early rheumatoid arthritis. These include pain, which is a major concern for patients, fatigue and persisting disease activity. The key therapeutic goal – remission of these clinical features – is achieved by 10–36% of early rheumatoid arthritis patients using currently available treatment. Disability, erosive damage and work disability are other important negative outcomes of early rheumatoid arthritis. Together, they account for its high direct and indirect medical costs. These various outcomes are outlined in this article.

Prednisolone plus a disease modifying antirheumatic drug improved outcomes in early rheumatoid arthritis

Source Citation Svensson B, Boonen A, Albertsson K, et al. Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis r...

How to predict prognosis in early rheumatoid arthritis

In early rheumatoid arthritis (RA), the objectives of therapeutic strategies are to obtain remission and prevent joint destruction as early as possible. These goals may be reached with conventional disease-modifying antirheumatic drugs (DMARDs) or with biological agents. In clinical practice, initial treatments are usually chosen according to the degree of disease activity at baseline, and adapted according to a step-up strategy. A more elegant therapeutic approach would be to choose the most appropriate treatment based on the prognosis of RA. Therefore, prognostic stratification could improve the relative roles and benefits of initial DMARD or biological therapy for early RA. For RA with a severe prognosis, a combination of DMARDs or biologicals could be initiated as the first-line therapy. However, we need to know how to predict outcome in early RA for this type of strategy. This review attempts to answer this question by reporting the most reliable prognostic factors and some predictive models proposed for classification into benign, mild and severe RA.

Early rheumatoid arthritis patients: relationship of age.

The aim of this study was to investigate if age at disease onset comprises a separate parameter for disease expression, prognosis, and outcome in early rheumatoid arthritis (RA) patients. Four hundred thirty-eight patients with early RA (disease duration less than 1 year) were studied. All of them fulfilled the American College of Rheumatology criteria for RA. The demographic, clinical, laboratory, radiologic, and therapeutic characteristics of the disease at diagnosis and during and at the end of follow-up (time period 1981-2000) were analyzed according to age at disease onset (young patients aged less than 60 years at disease onset vs elderly patients aged more than 60 years at disease onset). We found 317 young and 121 elderly patients with early RA. The male:female ratio, which was 1:3.2 in the young patients, was nearly equal in the elderly (1:1.4). In addition, at disease onset elderly patients showed more severe joint involvement (decreased grip strength) associated with high titers of acute phase response (erythrocyte sedimentation rate and C-reactive protein) than the younger patients. However, there were no differences between the two groups in the numbers of tender and swollen joints or acute phase response at the end of the study period. Furthermore, no differences were seen between the two groups concerning the presence of rheumatoid factor. Finally, the two patient groups showed the same degree of radiological changes and functional ability and were treated similarly, except for more frequent corticosteroid use in the elderly. We conclude that elderly patients present with more severe joint involvement at disease onset. However, at the end of the study, no differences were seen concerning radiological changes and functional ability. It seems that age at disease onset does not influence the clinical course and outcome of early RA patients.

Predicting outcomes in early rheumatoid arthritis.

Predicting outcomes in early rheumatoid arthritis.

The influence of HLA-DRB1 alleles and rheumatoid factor on disease outcome in an inception cohort of patients with early inflammatory arthritis.

There are conflicting data concerning the role of HLA-DRB1 alleles in disease outcome in early rheumatoid arthritis. The exact role of these alleles in short-term outcome is determined in this large, prospective, population-based study. We recruited 532 patients with inflammatory polyarthritis from the Norfolk Arthritis Register and typed their sera for HLA-DRB1 alleles using polymerase chain reaction-based methods. Disease outcome was assessed at 2 years in terms of persistent joint inflammation, functional disability, and radiologic erosions. Results are expressed as risk ratios (RR) with 95% confidence intervals (95% CI). There was no influence of HLA-DRB1 alleles, in any combination, on the likelihood of disease persistence, and only a modest effect on functional disability (Health Assessment Questionnaire score > or = 1). The most obvious effect was on the development of erosions (RR 1.9, 95% CI 1.4-2.6 for those who carried at least 1 DRB1 shared epitope [SE] allele), with slightly greater effects for those who were homozygous for SE-bearing alleles (RR 2.5, 95% CI 1.8-3.6). This effect of HLA-DRB1 was restricted to patients whose sera were negative for rheumatoid factor. Among patients with erosions, HLA-DRB1 had no influence on the severity of radiologic damage (defined as the number of eroded joints, or total Larsen score). These data do not support routine HLA-DRB1 screening of patients with early arthritis to identify those at risk for subsequent severe disease.