Prognostic factors of 10-year radiographic outcome in early rheumatoid arthritis: a prospective study.
BACKGROUND
The objectives of this study were to determine the predictive factors of long-term radiographic outcome of rheumatoid arthritis (RA) and to describe the relationship between joint damage and disability over the course of the disease.


METHODS
A cohort of 191 patients with early RA referred from primary care physicians were prospectively followed for 10 years. To determine the predictive factors of radiographic outcome, univariate analysis of the relationship between baseline values and outcome measures was undertaken using a chi-squared or Fisher's exact test. Stepwise multiple logistic regression was also performed to select independent prognostic factors.


RESULTS
From data available for 112 patients, univariate analysis revealed a total Sharp score at 10 years that was significantly correlated with erythrocyte sedimentation rate (ESR), presence and level of IgA rheumatoid factor, presence of an anti-citrullinated protein antibody (ACPA), serum level of matrix metalloproteinase-3 and radiographic score at baseline. Logistic regression identified the baseline erosion score to be the most important baseline parameter as an independent prognostic factor of total radiographic score at 10 years (odds ratio = 5.64; 95% confidence interval = 1.78 to 17.86). After excluding radiographic scores from the entry parameters, the presence of ACPA and ESR were also predictive of the final total Sharp score. The Health Assessment Questionnaire (HAQ) score was strongly correlated with disease activity parameters, such as disease activity score and pain, at baseline and at three, five and 10 years. No correlation was found between total radiographic Sharp score and HAQ score throughout the study.


CONCLUSIONS
In this prospective study, baseline radiographic score, ESR and ACPA were the best predictive factors of 10-year radiographic outcome in early RA. HAQ disability was associated with disease activity throughout the 10-year follow-up but not with joint damage. This discrepancy with previous reports may be due in part to the early start of therapy with disease-modifying anti-rheumatic drugs.
Courvoisier
Natacha
N
Service de Rhumatologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, Paris, 75012, France. natacha.courvoisier@sat.aphp.fr
Dougados
Maxime
M
Cantagrel
Alain
A
Goupille
Philippe
P
Meyer
Olivier
O
Sibilia
Jean
J
Daures
Jean Pierre
JP
Combe
Bernard
B
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D001799:Blood Sedimentation; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018501:Antirheumatic Agents
Arthritis Rheum. 1999 Sep;42(9):1854-60
10513799
Lancet. 1989 May 13;1(8646):1036-8
2565997
J Rheumatol. 1995 Jun;22(6):1037-42
7674227
Arthritis Rheum. 1992 Jan;35(1):26-34
1731813
Br J Rheumatol. 1995 Jun;34(6):529-34
7633794
Arthritis Res Ther. 2006;8(2):R40
16469118
J Rheumatol. 2000 Mar;27(3):571-4
10743791
J Clin Epidemiol. 2000 Oct;53(10):988-96
11027930
Clin Exp Rheumatol. 2003 Sep-Oct;21(5 Suppl 31):S20-7
14969046
Rev Rhum Mal Osteoartic. 1991 Jun;58(6):459-65
1896787
Arthritis Rheum. 1980 Feb;23(2):137-45
7362664
Rheumatology (Oxford). 2000 Jun;39(6):603-11
10888704
Arthritis Rheum. 2001 Sep;44(9):2009-17
11592361
Ann Rheum Dis. 2001 Oct;60(10):924-7
11557647
Ann Rheum Dis. 2004 Sep;63(9):1090-5
15308518
J Rheumatol. 2003 Nov;30(11):2344-9
14677175
Br J Rheumatol. 1996 Aug;35(8):746-51
8761186
Rheumatology (Oxford). 2003 Apr;42(4):553-62
12649403
J Rheumatol. 2000 Apr;27(4):888-93
10782811
Ann Intern Med. 1989 Feb 15;110(4):259-66
2913913
Ann Rheum Dis. 2005 Feb;64(2):196-201
15458956
J Rheumatol. 2003 Dec;30(12):2585-9
14719198
Arthritis Rheum. 1991 Jun;34(6):660-8
2053913
Ann Rheum Dis. 2002 Dec;61(12):1055-9
12429534
Scand J Rheumatol. 1995;24(3):146-53
7777825
Arthritis Rheum. 2002 Jan;46(1):21-30
11817593
Ann Rheum Dis. 2008 Feb;67(2):212-7
17526555
Arthritis Rheum. 2000 Jul;43(7):1478-87
10902749
Arthritis Rheum. 2002 Apr;46(4):913-20
11953967
Ann Rheum Dis. 2003 Jul;62(7):611-6
12810421
Ann Rheum Dis. 2006 Apr;65(4):453-8
16176994
Arthritis Rheum. 1998 Sep;41(9):1571-82
9751089
Scand J Rheumatol Suppl. 1985;57:1-54
3863243
Arthritis Rheum. 2001 Aug;44(8):1736-43
11508423
J Rheumatol. 1992 Mar;19(3):366-9
1578448
Arthritis Rheum. 2000 Apr;43(4):852-8
10765930
Br J Rheumatol. 1992 Aug;31(8):519-25
1386548
J Rheumatol Suppl. 2004 Mar;69:48-54
15053454
J Rheumatol. 1988 Oct;15(10):1480-8
3204597