Severity of RA is established within first 2 years

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Severity of rheumatoid arthritis is established within first 2 years

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WESTPORT, CT (Reuters Health) - The inflammatory course of rheumatoid

arthritis is set early in the disease process, according to an analysis

of prospectively collected data spanning 16 years. Dr. Frederick Wolfe,

of The National Data Bank for Rheumatic Diseases in Wichita, Kansas, and

Dr. Theodore Pincus, of Vanderbilt University School of Medicine in

Nashville, Tennessee, evaluated 21,866 erythrocyte sedimentation rate

(ESR) determinations from 1897 patients with rheumatoid arthritis.

Testing had been conducted between 1974 and 2000.

The ESR at disease onset averaged 37 mm/h, falling 4 mm/h over 10 years,

the researchers report in the Journal of Rheumatology for August. For

the next 20 years of disease, the ESR remained constant but rose

slightly thereafter. Patients seen over the last decade, when

methotrexate was more widely used, had lower ESR values, and the

reduction in ESR in the first 10 years was about 5 mm/h instead of 4

mm/h.

According to Dr. Wolfe, this analysis sets a baseline against which the

most recently introduced agents for the treatment of rheumatoid

arthritis, such as those that inactivate tumor necrosis factor, can be

compared. " If the new drugs are going to be useful, we'll need to see

the median ESR shift downward " over the entire course of the illness,

not just in the early years, he said in an interview with Reuters

Health.

The investigators report that " when patients with rheumatoid arthritis

of less than 2 years' duration were classified according to the quartile

of their ESR, these quartile positions were maintained over time. " " This

means that the disease course is set early by the intrinsic activity of

the disease, " Dr. Wolfe said. " On average, it is the severity of illness

that drives the outcomes of rheumatoid arthritis, irrespective of the

treatment we give them. "

Noting that his opinion is controversial, Dr. Wolfe added that the

people with the most severe disease may not be the ones who will have

the best outcomes when treated with the newer agents. Instead, he said,

" The people most likely to benefit from these drugs may have milder

arthritis than the patients in clinical trials. "

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