Prediction of 20-year outcome at onset of seropositive rheumatoid arthritis. Window of opportunity to achieve major outcomes in early rheumatoid arthritis patients: how persistence with therapy matters MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Five-year Favorable Outcome of Patients with Early Rheumatoid Arthritis in the 2000s: Data from the ESPOIR Cohort The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Ten year outcome in a cohort of patients with early rheumatoid arthritis: health status, disease process, and damage Anticarbamylated protein antibodies are associated with long-term disability and increased disease activity in patients with early inflammatory arthritis: results from the Norfolk Arthritis Register Prognostic factors of 10-year radiographic outcome in early rheumatoid arthritis: a prospective study Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. Hand function and activity limitation according to health assessment questionnaire in patients with rheumatoid arthritis and healthy referents: 5-year followup of predictors of activity limitation (The Swedish TIRA Project). Do Radiographic Joint Damage and Disease Activity Influence Functional Disability Through Different Mechanisms? Direct and Indirect Effects of Disease Activity in Established Rheumatoid Arthritis
OBJECTIVE With the advent of new and expensive antirheumatic treatments with potentially serious side effects , it would be essential to identify as early as possible those rheumatoid arthritis ( RA ) patients who have a poor prognosis . Here study was made of the prognostic value of different markers recorded at the onset of RA . METHODS At the 20-year follow-up of our prospect i ve study , 66 patients had rheumatoid factor-positive ( RF+ ) RA . At commencement of follow-up ( disease duration < 6 months ) , the prognostic value of 19 demographic , laboratory , clinical and radiographic variables was tested to explain the 20-year Larsen score for peripheral joints and the Health Assessment  Question naire ( HAQ ) index using Somers'd for asymmetrical associations . RESULTS An association was observed between onset blood platelets ( 0.17 ) , serum IgG ( 0.18 ) , the onset Larsen score ( 0.33 ) and the 20-year Larsen score . Old age ( 0.30 ) , serum orosomucoid ( 0.17 ) , the function score ( 0.28 ) , morning stiffness ( 0.28 ) , and grip strength ( 0.24 ) were associated with the 20-year HAQ . CONCLUSION The correlation between the investigated entry variables and end-point outcome was poor . In our discussion we conclude that the most important prognostic factor in RF + RA is the treatment Introduction Benefits of disease-modifying anti-rheumatic drugs ( DMARD ) in early rheumatoid arthritis patients ( ERAP ) will be achieved if patients follow prescribed treatment . Objective was to investigate whether timing of first non-persistence period and /or duration of persistence during the first 4 years of follow-up predicted disease outcomes at the 5th year in a cohort of ERAP , initiated in 2004 . Patients and Methods Up to February 2015 , charts of 107 ERAP with at least 5 years of follow-up and prospect i ve 6-month assessment s of disease activity , disability and persistence were review ed . Non-persistence was defined as omission of DMARD and /or corticosteroids for at least 7 consecutive days ; regarding methotrexate , one weekly missing dose was considered non-persistence . Persistence was recorded through an interview ( up to 2008 ) and thereafter through a question naire ; persistence duration was recorded in months of continuous medicationtaking . At the 5th year , disease activity was defined according to Disease Activity Score (DAS)28 , and disability according to Health Assessment Question naire ( HAQ ) . Descriptive statistics and linear and Cox regression analyses were used . Results At study entry , patients were more frequently middle-aged ( 39.1 ± 13.3 years ) and female ( 88.8 % ) , as well as more likely to have  high disease activity and disability . Over the first 4 years of follow-up , 54.2 % of the patients had indications for oral corticosteroids and all traditional DMARDs . Almost 70 % had at least one period of non-persistence , and their follow-up ( median , 25th–75th interquartile range ) to first non-persistence period was 13 months ( 1–31 ) . Persistence duration during the first 4 years predicted subsequent DAS28 ( in addition to gender and baseline DAS28 ) and HAQ ( in addition to age ) . During the 5th year , 68 patients ( 56 women )  achieved sustained remission ( DAS28 < 2.6 ) . In female population ( n = 95 ) , baseline DAS28 ( odds ratio [ OR ] , 0.65 ; 95 % confidence interval [ CI ] , 0.50–0.83 ; p = 0.001 ) and persistence duration ( OR , 1.04 ; 95 % CI , 1–1.08 ; p = 0.05 ) were predictors . Also , 84 patients  achieved sustained function ( HAQ < 0.21 ) , and baseline DAS28 and age were the only predictors . Timing of first non-persistence period did not impact outcomes . Conclusions Persistence duration with DMARDs within the first 4 years of RA predicted subsequent favorable outcomes in ERAP ; additional predictors were younger age , male gender and lower disease activity at diagnosis OBJECTIVES To determine whether magnetic resonance ( MR ) scans of the dominant wrist of patients with early rheumatoid arthritis ( RA ) can be used to predict functional outcome at 6 years ' follow up . METHODS  Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation . Patients were followed up prospect ively for 6 years , and further scans obtained at 1 year ( 42 patients ) and 6 years ( 31 patients ) . Two radiologists scored scans for synovitis , tendonitis , bone oedema , and erosions . The Stanford Health Assessment Question naire ( HAQ ) score , indicating functional outcome , and st and ard measures of disease activity were assessed at 0 , 1 , 2 , and 6 years . The physical function component of the SF-36 score ( PF-SF36 ) was also used as a functional outcome measure at 6 years . RESULTS Baseline MR parameters , including bone oedema score and the total baseline MR score , were predictive of the PF-SF36 at 6 years ( R2 = 0.22 , p = 0.005 and R2 = 0.16 , p = 0.02 , respectively ) . The PF-SF36 score correlated strongly with the HAQ score at 6 years ( rs = -0.725 , p<0.0001 ) ; none of the baseline MR parameters predicted the 6 year HAQ score . The total MR score obtained at 1 year was predictive of the 6 year HAQ ( R2 = 0.04 , p = 0.01 ) . St and ard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36 , but when combined in a model with baseline MR oedema score , prediction increased from 0.09 to 0.23 , or 23 % of the 6 year variance . CONCLUSION MR imaging of the wrist  in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage Objective . To report the 5-year outcome of a large prospect i ve 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 Question naire ( HAQ ) 1.0 ± 0.7 ; 45.8 % and 38.7 % had rheumatoid factor or antibodies to cyclic citrullinated peptide ( anti-CCP ) , respectively ; 22 % had h and 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 . Conclusion . 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 OBJECTIVE To investigate the relationship between functional capacity , disease activity , and joint destruction over the course of rheumatoid arthritis ( RA ) . METHODS The followup data on 378 patients with early RA ( duration < 1 year ) , included in an open , prospect i ve study since 1985 at the Department of Rheumatology of the University Medical Center Nijmegen , were used .  Functional capacity , disease activity , and joint destruction were assessed using the  Health Assessment Question naire disability index ( HAQ DI ) , the Disease Activity Score ( DAS ) , and a modification of the sharp radiographic damage score  , respectively . Multiple linear regression was used to model the data collected at 0 , 3 , 6 , and 9 years after study start , to investigate which variables influenced functional capacity during the disease course . A general linear mixed model for longitudinal data , which included the variables identified as significant in the multiple linear regression models and several interaction terms between the variables , was run . RESULTS On average , the functional capacity of the patients , as measured by the HAQ DI , worsened over the course of the disease after an initial improvement . After an initial reduction in the extent of disease activity , the mean DAS remained more or less stable over the course of the disease . The mean modified sharp joint damage score worsened over the course of the disease , with a slower progression rate later in the disease . In the multiple linear regression at 0 , 3 , and 6 years after study start , disease activity was found to be an important factor influencing functional capacity , and at 6 and 9 years , joint damage had an important effect on functional capacity . Furthermore , at 6 and 9 years , there was an interaction effect of joint destruction with disease activity . In the general linear mixed model , disease activity , joint damage , and an interaction effect of disease activity and joint damage were the main factors explaining functional capacity . CONCLUSION The effect of disease activity and joint destruction on functional capacity changes over the course of the disease . In early RA , functional capacity is most associated with disease activity , and in late disease , with joint damage Objective : To investigate outcome as measured by health status , disease process , and damage in an unselected group of patients with early rheumatoid arthritis ( RA ) monitored prospect ively for 10 years and to search for prognostic factors . Patients and methods : 183 patients with RA with disease duration < 2 years were assessed annually at a team care unit . Health status was measured by the  Health Assessment Question naire ( HAQ ) and functional class .  Disease process was assessed by clinical and laboratory measures of disease activity and evaluation of disease course . Damage was quantified as occurrence of major extra-articular manifestations and need for large joint replacements . Possible predictive factors were evaluated by logistic regression analyses . Results : 168/183 patients completed the entire follow up period . Of all 183 patients , 137 ( 75 % ) had been treated with disease modifying antirheumatic drugs and 84 ( 46 % ) with low dose oral glucocorticoids . After 10 years 158 patients ( 94 % ) managed daily life activities independently ( functional class I – II ) . As measured by the HAQ 20 % had almost no disability , 28 % were mildly disabled , and 10 % were seriously disabled . Median HAQ score had increased from 0.8 to 1.1 ( p<0.001 ) . Disease activity was significantly reduced . 133 patients ( 79 % ) had a relapsing remitting disease course and 30 patients ( 18 % ) were in remission as defined by the American College of Rheumatology criteria . Thirty patients ( 17 % ) had undergone large joint replacements . Fifteen patients ( 8 % ) had developed major extra-articular complications . The HAQ score during the first three months predicted disability at 10 years with an odds ratio of 13.4 . Conclusions : Prospect i ve studies such as this give important knowledge of the variable long term prognosis of RA and provide necessary background information for clinical trials of new treatment modalities Objectives Anticarbamylated protein ( anti-CarP ) antibodies are a novel family of autoantibodies recently identified in patients with inflammatory arthritis . The aim of this study was to investigate their association with long-term outcomes of disability and disease activity over 20 years ’ follow-up in a cohort of patients with inflammatory polyarthritis ( IP ) . Methods Norfolk Arthritis Register recruited adults with recent-onset swelling of ≥2 joints for ≥4 weeks from 1990 to 2009 . At baseline , Health Assessment Question naire ( HAQ ) and 28 joint disease activity scores ( DAS28 ) were obtained , and C reactive protein , rheumatoid factor ( RF ) , anticitrullinated protein antibodies ( ACPA ) and anti-CarP antibodies were measured . Further HAQ scores and DAS28 were obtained at regular intervals over 20 years . Generalised estimating equations were used to test the association between anti-CarP antibody status and longitudinal HAQ and DAS28 scores ; adjusting for age , gender , smoking status , year of inclusion and ACPA status . Analyses were repeated in subgroups stratified by ACPA status . The relative association of RF , ACPA and anti-CarP antibodies with HAQ and DAS28 scores was investigated using a r and om effects model . Results 1995 patients were included ; 1310 ( 66 % ) were female . Anti-CarP antibodies were significantly associated with more disability and higher disease activity , HAQ multivariate β-coefficient ( 95 % CI ) 0.12 ( 0.02 to 0.21 ) , and these associations remained significant in the ACPA-negative subgroups . The associations of RF , ACPA and anti-CarP antibodies were found to be additive in the r and om effects model . Conclusions Anti-CarP antibodies are associated with increased disability and higher disease activity in patients with IP . Our results suggest that measurement of anti-CarP antibodies may be useful in identifying ACPA-negative patients with worse long-term outcomes . Further , anti-CarP antibody status provided additional information about RF and ACPA Introduction 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 prospect ively 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 Question naire ( 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 prospect i ve 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 OBJECTIVE To determine prognostic factors of disability in early rheumatoid arthritis ( RA ) and to investigate the radiological and functional course of the disease . METHODS A total of 191 patients with early RA ( diagnosed for less than one year ) according to American College of Rheumatology criteria were followed prospect ively for 5 years . At baseline and at endpoint ,  Stanford Health Assessment Question naire ( HAQ ) scores and radiological scores  ( Sharp 's score modified by van der Heijde ) were performed . Correlations between numerous baseline data and HAQ score at endpoint were analyzed , using nonparametric tests . A multilinear regression model was performed to select independent prognostic factors of HAQ disability . RESULTS During the 5-year followup , mean HAQ decreased from 1.3 ( + /- 0.7 ) to 0.6 ( + /- 0.6 ) . There were 98 ( 65.3 % ) patients with a score > 1 point at baseline , but only 46 ( 27.4 % ) after 3 years and 34 ( 21.8 % ) after 5 years . Moreover , 90 % of the patients had an improvement of the disability score . Final HAQ disability was associated with baseline values of HAQ score , Pain , Ritchie index , tender joint count , Disease Activity Score , erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , and erosion . Multivariate analysis selected baseline HAQ score , Ritchie index , ESR , CRP , and presence of erosion as independent prognostic factors of HAQ disability . The probability cutoff in the logistic model was selected to minimize the sum of false positive and false negative values : negative predictive value = 92.71 % , positive predictive value = 46.15 % , p = 0.408 . Sex , age , IgM and IgA rheumatoid factors , other tested autoantibodies , and HLA class II genes did not contribute significantly to prediction of the disability after 5 years . At baseline , mean scores were 3.6 units ( + /- 7.7 ) for total radiological score , 1.7 ( + /- 4.5 ) for erosion score , and 1.9 ( + /- 3.7 ) for joint space narrowing score . After 5 years , they were 17.9 + /- 22.3 , 6.9 + /- 9.5 , and 11.0 + /- 15.4 , respectively . No erosion was present at the start in 58.0 % of patients , compared to 24.2 % and 22.4 % at 3 and 5 years . Global radiographic progression concerned 87 patients ( 55.8 % ) during the 5 years . CONCLUSION During the first 5 years of RA , radiological damage increased progressively in half of the patients , whereas HAQ disability improved in most of them during the same period of time and could be predicted by baseline values of HAQ score , Ritchie index , ESR , CRP , and presence ( or absence ) of erosion OBJECTIVE This study identifies baseline predictors of future activity limitation in rheumatoid arthritis ( RA ) . To reinforce the utility of instruments assessing functional ability/activity limitation , we used reference data from healthy referents . METHODS This study includes 189 patients ( 69 % women ) with recent-onset RA ( onset of joint swelling not more than 12 months at diagnosis ) in a prospect i ve cohort ( " the Swedish TIRA project " ) during 27 months from 1996 through 1998 . Regular followups were done for a period of 5 years , and 123 healthy persons ( 50 % women ) were recruited as referents .  H and function was assessed by the  " grip ability test ( GAT ) " and " signals of functional impairment " ( SOFI ) . Grip force was measured with the electronic device Grippit . Activity limitation was assessed with the Swedish version of the Health Assessment Question naire ( HAQ ) . RESULTS Throughout the study and for both sexes , GAT , grip force , SOFI-h and , and HAQ were significantly different for the patients compared to healthy referents . In the healthy referents , HAQ was mainly related to age and GAT , whereas in RA HAQ was most obviously linked to grip force . Five years after diagnosis only 8 % of HAQ outcome was explained by the baseline measures : HAQ , grip force , SOFI-lower limb , sex , walking speed , and GAT . CONCLUSION Our study provides valuable reference data for several functional ability and activity limitation measures . The HAQ score was explained by different variables in healthy referents compared to patients with RA . Five years after diagnosis only 8 % of HAQ outcome was explained by the variables assessed at inclusion Objective . To explore the relationship between rheumatoid arthritis ( RA ) disease activity and functional disability over time , considering indirect ( predictive ) and direct ( concurrent ) associations as well as the influence of radiographic joint damage and treatment strategy . Methods . Functional disability [ Health Assessment Question naire ( HAQ ) ] , disease activity [ 28-joint Disease Activity Score ( DAS28 ) ] , and radiographic joint damage [ Sharp/van der Heijde score ( SHS ) ] were measured in 4 consecutive r and omized controlled trials with increasingly intensive ( tight control ) treatment strategies . Average followup time for the 3 cohorts was 97 , 53 , and 50 months , respectively . Next to current DAS28 , the previous DAS28 was used to study the predictive effect of a change in DAS28 on progression of functional disability ( HAQ ) . Finally , it was investigated whether SHS mediated the predictive effect of DAS28 . Results . In patients treated with intensive treatment strategies , the progression of HAQ over time was statistically significantly less ( p < 0.0001 ) . The predictive influence of DAS28 on HAQ progression increased over the duration of the disease . SHS was not found to influence HAQ progression and did not mediate the predictive effect of DAS28 . In the less intensively treated patients , the direct effect of disease activity decreased with disease duration , and contrarily , SHS did influence HAQ progression , but was not found to ( fully ) mediate the predictive effect of DAS28 . Conclusion . In patients with RA treated with modern treatment strategies , there is less functional decline over time . Further , disease activity does predict functional decline but joint damage does not . This might indicate that factors associated with cumulative disease activity but not visible on radiographs can influence functional decline in patients with RA . This further underlines the importance of disease activity as a treatment target in early RA and in established RA
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