The prognostic value of baseline erosions in undifferentiated arthritis.
BACKGROUND
Undifferentiated arthritis (UA) has a variable disease course; 40 to 50% of UA patients remit spontaneously, while 30% develop rheumatoid arthritis (RA). Identifying the UA patients who will develop RA is essential to initiate early disease-modifying anti-rheumatic drug (DMARD) therapy. Although the presence of bone erosions at baseline is predictive for a severe destructive disease course in RA, the prognostic importance of erosive joints for disease outcome in UA is unknown. This study evaluates the predictive value of erosive joints for the disease outcome in UA as measured by RA development and disease persistency.


METHODS
Baseline hands and feet radiographs of 518 UA patients were evaluated for erosions using a clinical definition as well as the Sharp/van der Heijde method. After 1 year follow-up, patients were re-assessed for the fulfillment of the 1987 ACR classification criteria for RA. Disease persistency was defined as the absence of sustained remission during all available follow-up (mean 8 +/- 3 years).


RESULTS
At baseline, 28.6% of UA patients had erosive joints. Presence of > or = 2 erosive joints showed a positive predictive value for RA development of 53% and for persistent disease of 68%. Patients with erosions that did not develop RA were less often anticyclic citrullinated peptide antibody (ACPA)+ve, rheumatoid factor (RF)+ve and had lower C-reactive protein (CRP), erythrocytic sedimentation rate (ESR) and number of swollen joints compared to those who developed RA. Feet erosions are equally predictive compared to erosions at hands.


CONCLUSIONS
Presence of > or = 2 erosive joints at baseline in UA patients gives a risk for RA development of 53% and for persistent disease of 68%, indicating that erosions in UA are not always predictive for unfavorable disease outcomes.
Thabet
Mohamed M
MM
Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden, PO Box 9600, 2300RC, The Netherlands. m.thabet@lumc.nl
Huizinga
Thomas W J
TW
van der Heijde
Désirée M
DM
van der Helm-van Mil
Annette H M
AH
D001168:Arthritis / Q000000981:diagnostic imaging / Q000473:pathology*; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000473:pathology*; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011859:Radiography