RT Journal Article
SR Electronic
T1 Early Local Swelling and Tenderness Are Associated with Large-joint Damage After 8 Years of Treatment to Target in Patients with Recent-onset Rheumatoid Arthritis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 624
OP 629
DO 10.3899/jrheum.121248
VO 40
IS 5
A1 Marianne van den Broek
A1 Linda Dirven
A1 Herman M. Kroon
A1 Margreet Kloppenburg
A1 H. Karel Ronday
A1 André J. Peeters
A1 Pit J.S.M. Kerstens
A1 Tom W.J. Huizinga
A1 Willem F. Lems
A1 Cornelia F. Allaart
YR 2013
UL http://www.jrheum.org/content/40/5/624.abstract
AB Objective. To assess whether early swelling and tenderness in large joints in patients with rheumatoid arthritis (RA) is predictive of later local damage and whether this leads to functional disability. Methods. Two-year clinical and 8-year radiological followup data from the BeSt study (trial numbers NTR262 and NTR265), a randomized controlled treat-to-target trial, were used. The association between early local joint swelling and/or tenderness (at least once, or for ≥ 2 consecutive visits) and later large-joint damage (Larsen score ≥ 1) was assessed using generalized estimating equations. The association between large-joint damage and functional ability [by Health Assessment Questionnaire (HAQ)] was assessed using logistic and linear regression analysis. Results. Clinical and 8-year radiological data were available for 290 patients. Concomitant local joint swelling and tenderness at least once in the first 2 years was independently associated with damage of the large joints (OR 2.5, 95% CI 1.7–3.6), as was swelling without tenderness (OR 2.0, 95% CI 1.1–3.6). Stronger effects were seen for persistent swelling and/or tenderness. Other independent predictors for joint damage were baseline erythrocyte sedimentation rate (OR 1.01, 95% CI 1.01–1.02) and the presence of rheumatoid factor and/or anticitrullinated protein antibodies (OR 2.5, 95% CI 1.5–4.1; and OR 2.2, 95% CI 1.3–3.8, respectively). Patients with large-joint damage had a higher HAQ score after 8 years than patients without (difference 0.15). Conclusion. Early local swelling and tenderness are independent predictors of later joint damage in these joints after 8 years of Disease Activity Score-guided treatment in patients with RA. This suggests that suppression of local inflammation could help prevent local damage and functional disability.