title: Very recent onset rheumatoid arthritis: clinical and serological patient characteristics associated with radiographic progression over the first years of disease.
abstract: OBJECTIVE
  Despite early recognition and disease modifying anti-rheumatic drug (DMARD) treatment, a sizable proportion of early rheumatoid arthritis (RA) patients show radiological progression. This study was performed to determine the frequency of erosive arthritis and the pace of radiological progression in an inception cohort of patients with very early RA (<or=3 months after onset of symptoms).
  
  
  METHODS
  In order to determine possible prognostic factors for development of erosive disease, we linked the clinical features of these patients to radiological progression in a regression model. About 55 patients with RA and follow-up of at least 3 yrs were analysed. All had complete series of clinical, serological and radiographic assessments. Radiographs were scored according to the Larsen method.
  
  
  RESULTS
  Erosive disease developed in 63.6% of the patients over 3 yrs, with the majority (74.3%) appearing already in the first and 97.2% by the end of the second year. Among all variables available, rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (anti-CCP) first presentation were the most predictive for both development of erosions and the degree of radiological progression. None of the clinical variables at the onset was useful to discriminate between erosive and non-erosive patients. In the final regression model, however, cumulative clinical activity substantially contributed to explaining radiological progression.
  
  
  CONCLUSIONS
  Despite early treatment, substantial damage occurred in some patients and was associated with presence of strong 'constitutive' predictors such as anti-CCP and RF as well as presence of high long-term clinical disease activity as indicated by C-reactive protein (CRP), swollen joint counts and the absence of a good clinical response (assessed by the failure to achieve lasting low disease activity).
authors.affiliation: Department of Rheumatology, Medical University of Vienna, Vienna, Austria. Klaus.machold@meduniwien.ac.at
authors.forename: K P
authors.initials: KP
authors.lastname: Machold
authors.forename: T A
authors.initials: TA
authors.lastname: Stamm
authors.forename: V P K
authors.initials: VP
authors.lastname: Nell
authors.forename: S
authors.initials: S
authors.lastname: Pflugbeil
authors.forename: D
authors.initials: D
authors.lastname: Aletaha
authors.forename: G
authors.initials: G
authors.lastname: Steiner
authors.forename: M
authors.initials: M
authors.lastname: Uffmann
authors.forename: J S
authors.initials: JS
authors.lastname: Smolen
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D011379:Prognosis; D011859:Radiography; D012217:Rheumatoid Factor / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor