TY - JOUR 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 SP - 624 LP - 629 DO - 10.3899/jrheum.121248 VL - 40 IS - 5 AU - Marianne van den Broek AU - Linda Dirven AU - Herman M. Kroon AU - Margreet Kloppenburg AU - H. Karel Ronday AU - André J. Peeters AU - Pit J.S.M. Kerstens AU - Tom W.J. Huizinga AU - Willem F. Lems AU - Cornelia F. Allaart Y1 - 2013/05/01 UR - http://www.jrheum.org/content/40/5/624.abstract N2 - 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. ER -