RESEARCH - Disease activity, smoking, and reproductive-related predictors of poor prognosis

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Journal of Rheumatology

March 2011

Disease Activity, Smoking, and Reproductive-related Predictors of Poor

Prognosis in Patients with Very Early Inflammatory Polyarthritis

SUZANNE M.M. VERSTAPPEN, MELANIE J. McCOY, CHRIS ROBERTS, NICOLA E.

DALE, ANDREW B. HASSELL and DEBORAH P.M. SYMMONS; the Steroids In Very

Early Arthritis Investigators

From the Arthritis Research UK Epidemiology Unit, and the Department

of Biostatistics, Manchester Academic Health Sciences Centre, the

University of Manchester, Manchester; and the University Hospital of

North Staffordshire, Stoke-on-Trent, United Kingdom. S.M.M.

Verstappen, MSc, PhD, Arthritis Research UK Epidemiology Unit,

Manchester Academic Health Sciences Centre, University of Manchester;

M.J. McCoy, BSc, Arthritis Research UK Epidemiology Unit, Manchester

Academic Health Sciences Centre, University of Manchester; C. ,

MSc, PhD, Department of Biostatistics, Manchester Academic Health

Sciences Centre, University of Manchester; N.E. Dale, MA, Arthritis

Research UK Epidemiology Unit, Manchester Academic Health Sciences

Centre, University of Manchester; A.B. Hassell, MD, MMedEd, FRCP,

University Hospital of North Staffordshire; D.P.M. Symmons, MD, FFPH,

FRCP, Arthritis Research UK Epidemiology Unit, Manchester Professor,

Academic Health Sciences Centre, University of Manchester.

Abstract

Objective. To identify disease activity, smoking, and

reproductive-related predictors of a poor prognosis in patients with

very early inflammatory polyarthritis (IP).

Methods. Patients with very early IP (symptom duration 4–11 weeks)

included in our study were participants in the STIVEA (Steroids In

Very Early Arthritis) randomized placebo-controlled trial. At

baseline, disease-related variables were measured and patients were

asked to complete a questionnaire covering smoking status and

reproductive questions. Baseline predictors of poor prognosis [i.e.,

the need to start disease-modifying antirheumatic drug (DMARD) therapy

by 6 months or the clinical diagnosis of rheumatoid arthritis (RA) at

12 months] were identified, applying logistic regression analyses

adjusted for treatment group.

Results. Rheumatoid factor (RF) positivity was one of the strongest

clinical predictors of a poor prognosis: OR for DMARD therapy at 6

months, 4.00 (95% CI 2.00–8.00) and OR for a diagnosis of RA at 12

months, 9.48 (95% CI 4.48–20.07). There was a significant association

between current smoking at baseline compared to never smoking and a

diagnosis of RA at 12 months (OR 3.15, 95% CI 1.16–8.56).

Conclusion. About 6 in 7 patients with very early RF-positive IP were

diagnosed with RA 1 year later. In addition, 1 in 4 IP patients who

smoke will develop RA later. It is recommended to treat RF-positive

patients who have IP with DMARD at presentation and to advise patients

to stop smoking.

http://jrheum.org/content/38/3/429.abstract

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