Recent-onset Inflammatory Arthritis Research Articles

How do general practitioners identify inflammatory arthritis? A cohort analysis of Dutch general practitioner electronic medical records.

To examine the symptoms, signs and additional investigations that general practitioners (GPs) used in the process of diagnosing recent-onset inflammatory arthritis. Here, we assumed that the recorded information was crucial in the diagnostic process of arthritis. A database including electronic medical records of 16 Dutch general practices with 44,350 patients was studied. Patients with an episode of RA and allied conditions according to the International Classification of Primary Care-1 code L88 (here summarized as inflammatory arthritis) in the period 2009-2013 were selected. Frequencies of symptoms, signs and performed additional investigations were evaluated and compared between referred and non-referred patients. A total of 126 patients were diagnosed with inflammatory arthritis. Information on symptom duration, symptom location, swelling, loss of function, redness and warmth were recorded in, respectively, 64, 90, 80, 52, 48 and 41% of patients. Information on morning stiffness, family history or the squeeze-test was provided in 20, 18 and 17% of patients. Symmetry, inflammatory type arthralgia and fist closure were not recorded. Acute phase reactants and auto-antibody tests were performed in 40-46% and 8-11%, respectively. Eighty-four patients (67%) were referred to secondary care. Symptoms located in the foot, morning stiffness, family history, myalgia, absence of redness and elevated acute phase reactants were associated with referral (all P < 0.05). GPs mainly used classical signs of inflammation to diagnose inflammatory arthritis. Other items that are regularly assessed in secondary care (morning stiffness, squeeze-test, family history) were infrequently recorded by GPs.

Diagnostic impact of routine Lyme serology in recent-onset arthritis: results from the ESPOIR cohort

ObjectivesLyme disease may be considered by rheumatologists in patients with recent-onset arthritis, even in the absence of suggestive symptoms. The aim of this study was to determine the diagnostic impact...

AB0042 Human Host Defense Peptide Cathelicidin (LL37) Serum Levels Are Increased in Anti-Cyclical Citrullinated Peptide Positive Patients with Recent Onset Inflammatory Arthritis

BackgroundDisruption of normal innate immune responses to pathogens and toxins may contribute to Rheumatoid Arthritis (RA) pathogenesis. The host defense peptide cathelicidin (LL37) is produced as part of the innate...

THU0404 Vitamin D level in patients with early arthritis. A preliminary report

BackgroundVitamin D, because of its pleiotropic effect, is involved in many aspects of pathophysiology including calcium-phosphorus metabolism, cellular growth and differentiation and immune functions. Epidemiological studies suggest that deficiency of...

Bilateral 3.0-Tesla MRI of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis

ObjectivesTo identify bilateral hand and wrist high field strength 3.0 Tesla MRI (3-T MRI) findings of synovial inflammation that are associated with progression to rheumatoid arthritis (RA) in a very...

Clinical, laboratory and genetic markers associated with erosions and remission in patients with early inflammatory arthritis: a prospective cohort study

We investigated the relationship between clinical, laboratory and genetic markers and outcome measures in 159 patients with recent onset of inflammatory arthritis (IA). The majority of patients were managed in community-based rheumatology practice. Median duration of arthritis at baseline was 3 months with median follow-up of 4.0 years (range 0-10). Markers of disease activity and 1987 ACR criteria for rheumatoid arthritis (RA) were estimated every 6 months for the first 2 years and annually thereafter. Presence of shared epitopes (SE) was established by PCR-based method. Main outcome variables were attainment of remission and presence of erosions on X-rays of hands and feet at 3 years. Remission was seen in 34.3% of patients and was independently related to age 60 and older (odds ratio (OR) 3.2; 95% confidence interval (CI), 1.2-8.7) and inversely to the presence of rheumatoid factor (RF) (OR 8.3; 95% CI, 3.2-21.3 for persistent arthritis). Patients with two SE were likely to have persistent arthritis (P=0.006), but this was not significant when corrected for RF. Independent predictors for erosions at 3 years were RF (OR 7.5; 95% CI, 1.9-29.5) and area under the curve for number of swollen joints (OR 1.08; 95% CI, 1.02-1.16). SE status was not predictive of erosions at 3 years (OR 1.6; 95% CI, 0.7-3.7). In univariate analysis, patients possessing DERAA motif on DRB1 were less likely to have erosive disease than without this motif at 4 years (OR 0.21; 95% CI, 0.0-0.9, P=0.037) but this finding was partly explained by adjusting for RF (adjusted OR 0.24; 95% CI 0.04-1.37). In this study of recent onset IA, active disease and RF were associated with poor outcome. Whilst SE did not predict erosive disease, patients with DERAA motif may be protected against erosions whilst the presence of two SE alleles suggests persistence of arthritis.

Predictive factors in early arthritis: long-term follow-up

Background Because recent-onset inflammatory arthritis exhibits considerable clinical and prognostic variability, it is important to attempt to predict which patients are likely to have a poor prognosis as early as possible. Most prognostic studies have looked at patients who fulfilled proposed criteria for a definite diagnosis of rheumatoid arthritis (RA) or other well-defined conditions; less information exists concerning predictive factors for other types of early arthritis. Objectives To examine prognosis in early arthritis, the authors assessed the long-term outcome in a cohort of patients who presented with inflammatory arthritis of short duration. Associations between outcome and patient clinical characteristics were analyzed to determine possible prognostic factors. Methods Since 1968, patients were selected to be followed up in 2 early-arthritis clinics if they had evidence of inflammatory joint disease and symptom duration was <1 year. Length of follow-up was variable, but was at least 1 year. At last follow-up, patients were classified as being in remission or as having persistent disease. Factors associated with a poor outcome were identified by using formal statistical methods. Results A total of 121 patients were included in this analysis. Mean disease duration to the first evaluation was 3 months, and median follow-up was 5 years (range, 1 to 30 months). Twenty-one patients (17%) had transient disease defined as total duration of <6 weeks. Sixty-three patients (52%) were in remission at final follow-up, with unclassified patients doing the best. Patients meeting criteria for RA or spondylarthropathies had more persistent disease. Polyarticular disease predicted more persistent disease ( P < .05). In multivariable analyses, patients with initial hand involvement were much less likely to achieve remission of their disease (odds ratio, 0.18; 95% confidence interval, 0.05 to 0.66). Only 4 patients had either class 4 function or joint replacement. Conclusions Our findings indicate that prognosis in early inflammatory arthritis is generally good, with more than half of all patients achieving remission in our cohort. Patients with unclassified arthritis fared better than those meeting criteria for RA or spondylarthropathy. Of the many clinical variables examined as possible prognostic factors, hand involvement was the strongest predictor of a poor outcome. Relevance The long follow-up of these patients with early arthritis provides clues for the clinician to the likely course and shows that many patients will do well.

A physically demanding occupation predicts premature retirement among patients with erosive arthritis

The aim of this study was to assess the intensity of exercise and energy expenditure of patients with recent onset inflammatory arthritis in their occupational environments and leisure time physical activities. The exercise intensities and energy expenditures of 41 early inflammatory arthritis patients and 20 matched healthy controls were assessed in occupational work and in leisure time physical activities during a 3.5-year follow-up using metabolic unit values. Disease activity was assessed by erythrocyte sedimentation rate and Ritchie's articular index. Subjective disability was assessed by the Stanford Health Assessment Questionnaire and the extent of joint damage on X-rays of the hands and feet following the method of Larsen et al (1977). Furthermore, 21 patients initially carried out progressive strength training for a 6-month period, while the rest of the subjects only maintained their daily physical activities. Our results indicate that the high physical requirements of occupational work were related to the development of joint destruction, work disability and the premature professional retirement of the inflammatory arthritis patients. The exercise intensities and energy expenditures in leisure time physical activities were lower when compared with daily work and were of minor importance. However, the 6-month strength training had a positive impact on patient outcome. Patients in physically demanding jobs who contract inflammatory arthritis need early occupational and physical rehabilitation to prevent progressive structural joint damage and premature retirement.

Effects of Strength Training on Neuromuscular Function and Disease Activity in Patients with Recent-onset Inflammatory Arthritis

Thirty-nine consecutive patients with recent-onset rheumatoid or psoriatic arthritis were randomly allotted for six months period either to the experimental progressive dynamic strength training group (EG, 10 women and 11 men; 41 +/- 10 yrs), or to the control group (CG, 10 women and 8 men; 45 +/- 11 yrs) who just maintained their habitual physical activities. All patients received antirheumatic medication throughout the experimental period. During the study period significant improvements took place in the EG in maximal muscle strength of all examined muscle groups (31.5% for the knee extensors, p < 0.001; 14.8% and 10.7% for the trunk flexors and extensors, p < 0.01; 27.8% and 20.4% for grip strength, p < 0.001) as well as in erytrocyte sedimentation rate (p < 0.05). Ritchie's articular index (RI) (p < 0.001) and HAQ (p < 0.01). In the CG only the decrease in RI was statistically significant (p < 0.05). Erosive changes in joints increased only slightly and less in the EG than in the CG. The present results suggest that dynamic strength training in early arthritis increases the neuromuscular performance without detrimental effects on disease activity or joint damage.