Very recent onset arthritis--clinical, laboratory, and radiological findings during the first year of disease.
OBJECTIVE
To describe clinical and radiological findings in patients with very early arthritis (< 3 months of symptoms) during one year of observation.


METHODS
In an Austrian multicenter setting, patients were eligible if they had nontraumatic swelling or pain in at least one joint and laboratory signs of inflammation [elevated erythrocyte sedimentation rate, C-reactive protein, leukocytosis, or rheumatoid factor (RF)] within the last 3 months. Clinical and laboratory assessments were performed every 3 months. Radiographs of hands and feet were taken at entry and after one year. Treatment decisions were left to the discretion of the participating center.


RESULTS
In total, 108 patients included between 1996 and 2000 had followup investigations during at least one year; 61.1% of these patients had rheumatoid arthritis (RA). Over 65% of RA diagnoses were made at the first visit. Lag time to referral was significantly longer in patients with RA than in patients with other inflammatory joint diseases (median 8 vs 4 weeks). Disease modifying antirheumatic drugs were started 19 +/- 10 (mean +/- SD) weeks after symptom onset in patients with RA. Patients with RA improved significantly (by American College of Rheumatology response criteria and the Disease Activity Score 28) during the first year. Erosions were present in 12.8% of RA patients' initial radiographs, compared to 27.6% after one year. Odds ratio to develop new erosions during the first year of RA was 9.7 (95% CI 1.05-89.93) in RF+ patients compared to RF- individuals (p < 0.05).


CONCLUSIONS
When early referral of patients with arthritis is encouraged, RA can be diagnosed and treatment initiated early, with significant clinical response. Moreover, patients with RA tend to be referred later than patients with other inflammatory joint diseases; RA patients at this very early stage have low frequency of joint damage; and RF predicts erosions in the first year.
Machold
Klaus P
KP
Department of Rheumatology, University of Vienna, Vienna, Austria.
Stamm
Tanja A
TA
Eberl
Gabriele J M
GJ
Nell
Valerie K P
VK
Dunky
Attila
A
Uffmann
Martin
M
Smolen
Josef S
JS
D000328:Adult; D017668:Age of Onset; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000000981:diagnostic imaging* / Q000473:pathology; D001175:Arthrography; D001799:Blood Sedimentation; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D007596:Joints / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012217:Rheumatoid Factor / Q000097:blood; D011795:Surveys and Questionnaires
D018501:Antirheumatic Agents; D018836:Inflammation Mediators; D002097:C-Reactive Protein; D012217:Rheumatoid Factor