PT  - JOURNAL ARTICLE
AU  - Klaus P Machold
AU  - Tanja A Stamm
AU  - Gabriele J M Eberl
AU  - Valerie K P Nell
AU  - Attila Dunky
AU  - Martin Uffmann
AU  - Josef S Smolen
TI  - Very recent onset arthritis--clinical, laboratory, and radiological findings during the first year of disease.
DP  - 2002 Nov 01
TA  - The Journal of Rheumatology
PG  - 2278--2287
VI  - 29
IP  - 11
4099  - http://www.jrheum.org/content/29/11/2278.short
4100  - http://www.jrheum.org/content/29/11/2278.full
SO  - J Rheumatol2002 Nov 01; 29
AB  - OBJECTIVE: To describe clinical and radiological findings in patients with very early arthritis (< 3 months of symptoms) during one year of observation. METHODS: In an Austrian multicenter setting, patients were eligible if they had nontraumatic swelling or pain in at least one joint and laboratory signs of inflammation [elevated erythrocyte sedimentation rate, C-reactive protein, leukocytosis, or rheumatoid factor (RF)] within the last 3 months. Clinical and laboratory assessments were performed every 3 months. Radiographs of hands and feet were taken at entry and after one year. Treatment decisions were left to the discretion of the participating center. RESULTS: In total, 108 patients included between 1996 and 2000 had followup investigations during at least one year; 61.1% of these patients had rheumatoid arthritis (RA). Over 65% of RA diagnoses were made at the first visit. Lag time to referral was significantly longer in patients with RA than in patients with other inflammatory joint diseases (median 8 vs 4 weeks). Disease modifying antirheumatic drugs were started 19 +/- 10 (mean +/- SD) weeks after symptom onset in patients with RA. Patients with RA improved significantly (by American College of Rheumatology response criteria and the Disease Activity Score 28) during the first year. Erosions were present in 12.8% of RA patients' initial radiographs, compared to 27.6% after one year. Odds ratio to develop new erosions during the first year of RA was 9.7 (95% CI 1.05-89.93) in RF+ patients compared to RF- individuals (p < 0.05). CONCLUSION: When early referral of patients with arthritis is encouraged, RA can be diagnosed and treatment initiated early, with significant clinical response. Moreover, patients with RA tend to be referred later than patients with other inflammatory joint diseases; RA patients at this very early stage have low frequency of joint damage; and RF predicts erosions in the first year.