Five-year favorable outcome of patients with early rheumatoid arthritis in the 2000s: data from the ESPOIR cohort.
OBJECTIVE
To report the 5-year outcome of a large prospective cohort of patients with very early rheumatoid arthritis (RA), and to identify factors predictive of outcome.


METHODS
Patients were recruited if they had early arthritis of < 6 months' duration, had a high probability of developing RA, and had never been prescribed disease-modifying antirheumatic drugs (DMARD) or steroids. Logistic regression analysis was used to determine factors that predict outcome.


RESULTS
We included 813 patients from December 2002 to April 2005. Age was 48.1 ± 12.6 years, delay before referral 103.1 ± 52.4 days, 28-joint Disease Activity Score (DAS28) 5.1 ± 1.3, Health Assessment Questionnaire (HAQ) 1.0 ± 0.7; 45.8% and 38.7% had rheumatoid factor or antibodies to cyclic citrullinated peptide (anti-CCP), respectively; 22% had hand or foot erosions; 78.5% fulfilled the American College of Rheumatology/European League Against Rheumatism criteria for RA at baseline and 93.8% during followup. At 5 years, 573 patients were evaluated. The outcome was mild for most patients: disease activity (median DAS28 = 2.5) and HAQ disability (median 0.3) were well controlled over time; 50.6% achieved DAS28 remission and 64.7% low disease activity. Radiographic progression was low (2.9 Sharp unit/year) and only a few patients required joint surgery. Nevertheless, some patients developed new comorbidities. During the 5 years, 82.7% of patients had received at least 1 DMARD (methotrexate, 65.9%), 18.3% a biological DMARD, and about 60% prednisone at least once. Anti-CCP was the best predictor of remaining in the cohort for 5 years, of prescription of synthetic or biologic DMARD, and of radiographic progression.


CONCLUSIONS
The 5-year outcome of an early RA cohort in the 2000s was described. Anti-CCP was a robust predictor of outcome. The generally good 5-year outcome could be related to early referral and early effective treatment, key processes in the management of early RA in daily practice.
From the Lapeyronie Hospital, Montpellier I University, UMR 5535, EA2415, Montpellier; Paris-Bichat University Hospital, AP-HP; Paris St. Antoine University Hospital, Paris; Toulouse University Hospital, Toulouse; Paris-Descartes University; UPRES-EA 4058; Cochin Hospital, Paris; Amiens University Hospital, Amiens; Paris-Pitié Salpêtrière University Hospital, Paris; Lille University Hospital, Lille 2 University, Lille; Tours University Hospital, UMR CNRS 7292, University of Tours, Tours; Nancy University Hospital, Institut National de la Santé et de la Recherche Médicale (INSERM) CIE6, Nancy; INSERM U905, Institute for Research and Innovation in Biomedicine, Rouen University, Rouen; MSD Paris; Université Paris-Sud, AP-HP, Hôpitaux Universitaires Paris-Sud; INSERM U738, AP-HP, Hotel Dieu, Paris; Brest University Hospital, Brest; Bordeaux University Hospital, Bordeaux; and Strasbourg University Hospital, Strasbourg, France.
Bernard
B
Combe
Nathalie
N
Rincheval
Joelle
J
Benessiano
Francis
F
Berenbaum
Alain
A
Cantagrel
Jean-Pierre
JP
Daurès
Maxime
M
Dougados
Patrice
P
Fardellone
Bruno
B
Fautrel
Rene M
RM
Flipo
Philippe
P
Goupille
Francis
F
Guillemin
Xavier
X
Le Loët
Isabelle
I
Logeart
Xavier
X
Mariette
Olivier
O
Meyer
Philippe
P
Ravaud
Alain
A
Saraux
Thierry
T
Schaeverbeke
Jean
J
Sibilia
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001175:Arthrography; D001688:Biological Products / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction / Q000379:methods; D012217:Rheumatoid Factor; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D001688:Biological Products; D012217:Rheumatoid Factor; D008727:Methotrexate
EARLY ARTHRITIS; ESPOIR COHORT; OUTCOME; RHEUMATOID ARTHRITIS; TREATMENT; UNDIFFERENTIATED ARTHRITIS