RESEARCH - Predicting arthritis outcomes - what can be learned from the Leiden Early Arthritis Clinic?

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Predicting Arthritis Outcomes—What Can Be Learned From the Leiden

Early Arthritis Clinic?

Diederik P. C. de Rooy; P. M. van der Linden; Knevel;

Tom W. J. Huizinga; Annette H. M. van der Helm-van Mil

Posted: 02/13/2011; Rheumatology. 2010;51(1):93-100.

Abstract

Objectives. In order to allow personalized medicine, adequate

prediction of disease outcome is required. In early undifferentiated

arthritis (UA), prediction of the development of RA is crucial, and in

case of RA predicting the severity of the disease course may guide

individualized treatment decisions.

Methods. A total of 570 UA patients and 676 RA patients included in

the Leiden Early Arthritis Clinic cohort were studied for baseline

characteristics. The disease outcomes studied were fulfilment of the

1987 ACR-RA criteria and arthritis persistence in UA patients and the

rate of radiological joint destruction and achieving sustained

DMARD-free remission in RA patients.

Results. Predictive factors for fulfilment of the 1987 ACR-RA criteria

and for persistent arthritis in UA were largely similar. Risk factors

for a severe rate of joint destruction were: older age (P < 0.001);

male gender (P < 0.001); longer symptom duration at first visit (P =

0.048), involvement of lower extremities (P < 0.001); BMI (P < 0.001);

high acute phase reactants, presence of IgM-RF (P < 0.001); anti-CCP2

antibodies (P < 0.001); anti-modified citrullinated vimentin

antibodies (P < 0.001) and HLA-DRB1 shared epitope alleles (P =

0.001). A high BMI was associated with a lower rate of joint

destruction but with a higher risk of disease persistence. The

proportion of variance in joint destruction explained was 32%

Conclusion. Predictors for RA development, previously used to develop

a prediction rule in UA patients, are largely similar to predictors

for arthritis persistency. Only part of the joint destruction level in

RA is explained by the currently known risk factors. New factors need

to be identified in order to guide pharmaceutical intervention at the

level of individual RA patients.

Introduction

The outcome of early arthritis patients is highly variable.

Approximately only one-third of the patients with a recent-onset

undifferentiated arthritis (UA) progress to RA. The severity of the

progression of joint destruction in RA is highly variable as well, as

only a minority will become severely destroyed. In order to achieve

individualized treatment decision-making, the severity of the disease

outcome needs to be estimated adequately. This is particularly

relevant since it is widely acknowledged that early initiation of

treatment of RA is effective in diminishing the level of joint

destruction and disability.[1–3] Fewer studies are performed on the

effects of early intervention in recent-onset UA, but available data

suggest that early treatment strategies hamper progression in UA as

well.[4–6] Potent treatment strategies such as targeted therapies are

generally not started in an early phase because of the risk of

overtreatment. However, when the individuals who will have an

unfavourable disease outcome can be identified at first presentation,

the risk of overtreatment and undertreatment can be balanced,

resulting in a personalized pharmaceutical regimen.

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Read the full article here:

http://www.medscape.com/viewarticle/735767

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