title: Early local swelling and tenderness are associated with large-joint damage after 8 years of treatment to target in patients with recent-onset rheumatoid arthritis.
abstract: OBJECTIVE
  To assess whether early swelling and tenderness in large joints in patients with rheumatoid arthritis (RA) is predictive of later local damage and whether this leads to functional disability.
  
  
  METHODS
  Two-year clinical and 8-year radiological followup data from the BeSt study (trial numbers NTR262 and NTR265), a randomized controlled treat-to-target trial, were used. The association between early local joint swelling and/or tenderness (at least once, or for ≥ 2 consecutive visits) and later large-joint damage (Larsen score ≥ 1) was assessed using generalized estimating equations. The association between large-joint damage and functional ability [by Health Assessment Questionnaire (HAQ)] was assessed using logistic and linear regression analysis.
  
  
  RESULTS
  Clinical and 8-year radiological data were available for 290 patients. Concomitant local joint swelling and tenderness at least once in the first 2 years was independently associated with damage of the large joints (OR 2.5, 95% CI 1.7-3.6), as was swelling without tenderness (OR 2.0, 95% CI 1.1-3.6). Stronger effects were seen for persistent swelling and/or tenderness. Other independent predictors for joint damage were baseline erythrocyte sedimentation rate (OR 1.01, 95% CI 1.01-1.02) and the presence of rheumatoid factor and/or anticitrullinated protein antibodies (OR 2.5, 95% CI 1.5-4.1; and OR 2.2, 95% CI 1.3-3.8, respectively). Patients with large-joint damage had a higher HAQ score after 8 years than patients without (difference 0.15).
  
  
  CONCLUSIONS
  Early local swelling and tenderness are independent predictors of later joint damage in these joints after 8 years of Disease Activity Score-guided treatment in patients with RA. This suggests that suppression of local inflammation could help prevent local damage and functional disability.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. m.van_den_broek@lumc.nl
authors.forename: Marianne
authors.initials: M
authors.lastname: van den Broek
authors.forename: Linda
authors.initials: L
authors.lastname: Dirven
authors.forename: Herman M
authors.initials: HM
authors.lastname: Kroon
authors.forename: Margreet
authors.initials: M
authors.lastname: Kloppenburg
authors.forename: H Karel
authors.initials: HK
authors.lastname: Ronday
authors.forename: André J
authors.initials: AJ
authors.lastname: Peeters
authors.forename: Pit J S M
authors.initials: PJ
authors.lastname: Kerstens
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Cornelia F
authors.initials: CF
authors.lastname: Allaart
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004185:Disability Evaluation; D004359:Drug Therapy, Combination; D004487:Edema; D005260:Female; D006304:Health Status; D006801:Humans; D000069285:Infliximab; D007596:Joints / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D020127:Recovery of Function; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D011239:Prednisolone; D000069285:Infliximab; D008727:Methotrexate
keywords: LARGE-JOINT DAMAGE; LARSEN SCORE; RHEUMATOID ARTHRITIS; SYNOVITIS; TREAT TO TARGET