Recent-onset Inflammatory Polyarthritis Research Articles

A recent onset inflammatory polyarthritis register in Spain: factors that predict remission

Objective: To identify baseline variables that predict remission at 1 year in patients with recent onset inflammatory polyarthritis (IP).Methods: We prospectively studied 167 patients aged ⩾16 years with a 4‐week to 12‐month history of swelling of ⩾2 joints. At baseline, no patient had previously received corticosteroids or disease‐modifying anti‐rheumatic drugs (DMARDs). To adjust for differences in baseline variables associated with the type of treatment given (a surrogate marker of disease severity), we used regression analysis. The classification probability of treatment thus obtained was entered, along with other significant baseline variables, in a second separate regression analysis to identify variables that predicted remission (no swollen joints).Results: Frequency of remission was 50.9% at 1 year. In the first regression analysis, variables associated with treatment with DMARDs or DMARDs and corticosteroids versus corticosteroids alone included age, morning stiffness, swollen joint count (SJC), disease severity according to the patient, and rheumatoid factor (RF) level; the strongest association was for higher SJC. In the second regression analysis, the model that best predicted remission (correct in 70.1% of cases) included age, tender joint count (TJC), erythrocyte sedimentation rate (ESR), RF, total Sharp score, disease severity according to the physician, and the 1987 American Rheumatism Association (ARA) criteria for rheumatoid arthritis (RA); the strongest association was for failure to meet these criteria. The model's sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve were 70.6%, 70.9%, and 75.4%, respectively.Conclusion: Although we identified some predictors of remission, no model accurately predicted remission at 1 year in this cohort.

Aspects of early arthritis. What determines the evolution of early undifferentiated arthritis and rheumatoid arthritis? An update from the Norfolk Arthritis Register

Over 3500 patients with recent onset inflammatory polyarthritis (IP) have been recruited by the Norfolk Arthritis Register (NOAR) since 1990. Longitudinal data from this cohort have been used to examine the prevalence and predictors of remission, functional disability, radiological outcome, cardiovascular mortality and co-morbidity and the development of non-Hodgkin's lymphoma. Rheumatoid factor titre, high baseline C-reactive protein and high baseline HAQ score are all predictors of a poor outcome. There is a strong association between possession of the shared epitope and the development of erosions. Patients who satisfy the American College of Rheumatology criteria for rheumatoid arthritis (RA) have a worse prognosis than those who do not. However, it appears that these patients are a poorly defined subset of all those with IP rather than having an entirely separate disease entity. New statistical techniques offer exciting possibilities for using longitudinal datasets such as NOAR to explore the long-term effects of treatment in IP and RA.

Coping and psychological adjustment in recent-onset inflammatory polyarthritis: the role of gender and age

To examine the role of gender, age and coping in psychological adjustment of patients with early inflammatory polyarthritis (IP). One hundred and twelve patients with IP of up to 18 months' duration from the Norfolk Arthritis Register completed questionnaires measuring coping, anxiety, disability and pain. Thirty-six per cent of the patients were at risk of depressive symptoms. Women had significantly higher levels of depression and anxiety than men. Regression analyses showed that pain and (low) illness acceptance predicted levels of depression. Younger age, wishful thinking and covering up predicted anxiety levels. The study found higher levels of depression and anxiety for women than men with early IP. Psychological distress was predicted by younger age, specific coping strategies and high levels of pain.