Share This Article:

Early Arthritics

Abstract Full-Text HTML Download Download as PDF (Size:355KB) PP. 94-101
DOI: 10.4236/ojra.2012.24018    2,905 Downloads   4,849 Views  

ABSTRACT

To determine which patients with Early Inflammatory Polyarthritis (EIP) with less than a year of evolution of the disease without a definitive diagnosis, progressed to rheumatoid arthritis according to ACR1987 criteria, we developed a predictive model for classification of early rheumatoid arthritis, based on clinical characteristics by observation of theonset of the disease and to relate with certain laboratory variables. A total of 54 patients with arthritis of less than one year of evolution were evaluated. We conducted a physical examination and the following parameters were determined: DAS 28, HAQ, Rheumatoid Factor (RF), Citrullinated Peptide (anti-CCP) and C-Telopeptide (CTx-II); radiology of hands and feet was also carried out, and was assessed by the Sharp method modified by van der Heijde. The patient follow-up was performed every 3 months for 12 months, classifying them according to the development of self-limiting, persistent non-erosive, and persistent erosive arthritis, and according to definite diagnosis. We estimated the relative risk and 95% confidence intervals for the predictor variables considered. Overall, 80.4% of patients with EIP evolved to persistent arthritis. Most persistent arthritis was diagnosed as rheumatoid arthritis (67.4%). However 51.6% (16/31) were anti-CCP positive, 21/31 (67.7%) were RF, and 11/31 (35%) were CTx-II positive. The basal nodes and RF were able to predict the persistence of activity and symmetry; rheumatoid nodules predict the development of erosions. It is important to note that patients who had an high initial average by the Sharp method modified by van der Heijde tend to have a greater increase in erosion at 6 months compared to those who had an initial low average (Pearson correlation coefficient 0.40, p < 0.015). An initial erosive disease increases the risk of radiological progression.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

M. Nuñez-Sotelo, L. Gutierrez-Gonzalez, N. Gonzalez and B. Losada, "Early Arthritics," Open Journal of Rheumatology and Autoimmune Diseases, Vol. 2 No. 4, 2012, pp. 94-101. doi: 10.4236/ojra.2012.24018.

References

[1] A. Saraux, J. Berthelot, G. Chalès, C. Lehenaff, J. Thorel, S. Hoang, et al., “Ability of the American College of Rheumatology 1987 Criteria to predict Rheumatoid Arthritis Patients with Early Arthritis and Classification,” Arthritis Rheuma, Vol. 44, No. 11, 2001, pp. 2485-2491. doi:10.1002/1529-0131(200111)44:11<2485::AID-ART428>3.0.CO;2-S
[2] P. Emery and D. Symmons, “What Is Early Rheumatoid Arthritis, Definition and Diagnosis,” Bailliére’s Clinical Rheumatology, Vol. 11, No. 1, 1997, pp. 13-26. doi:10.1016/S0950-3579(97)80030-1
[3] M. Weinblatt, “Rheumatoid Arthritis: Treat Now, Not Later,” Annals of Internal Medicine, Vol. 124, No. 8, 1996, pp. 773-774.
[4] T. M?tt?nen, P. Hannonén, M. Leirisalo-Repo, M. Nissila, H. Kautiainen, M. Korpela, et al., “Comparison of Combination Therapy with Single—Drug Therapy in Early Rheumatoid Arthritis: A Randomised Trial,” Lancet, Vol. 353, No. 9164, 1999, pp. 1568-1573. doi:10.1016/S0140-6736(98)08513-4
[5] M. Boers, A. Verhoeven, H. Markusse, M. Vandelaae, R. Westhovens, J. van Dendere, et al., ”Randomised Comparison of Combined Step-Down Prednisolone, Methotrexate and Sulphasalazine with Sulphasalazine Alone in Early Rheumatoid Arthritis,” Lancet, Vol. 350, No. 7094, 199, pp. 309-318. doi:10.1016/S0140-6736(97)01300-7
[6] D. L. Scott, “The Diagnosis and Prognosis of Earlyarthritis: Rationalefor New Prognosticcriteria,” Arthritis & Rheumatism, Vol. 46, No. 2, 2002, pp. 286-290. doi:10.1002/art.10134
[7] C. Reparon-Schuijt, W. J. E.Van Eschw, C. Kooten, G. Schellekens, B. Jong, et al., “Secretion of Anti-Citrulline— Containing Peptide ANTIBODY by B Lymphocytes in Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 44, No. 1, 2001, pp. 41-47. doi:10.1002/1529-0131(200101)44:1<41::AID-ANR6>3.0.CO;2-0
[8] H. Doyle and M. Mamula, “Post Translational Protein Mo- difications: New Flavours in the Menu of Autoantigens,” Current Opinion in Rheumatology, Vol. 14, No. 3, 2002, pp. 244-249. doi:10.1097/00002281-200205000-00009
[9] H. Visser, S. le Cessie, F. Breedueld, J. Hazes, et al., “How to Diagnose Rheumatoid Arthritis Early. A Prediction Model for Persistent (Erosive) Arthritis,” Arthritis & Rheumatism, Vol. 46, No. 2, 2002, pp. 357-365. doi:10.1002/art.10117
[10] P. Garnero, R. Landewé, M. Boers, A. Verhoeven, S. van Linden, S. Christgau, et al., “Association of Baseline of Markers of Bone and Cartilage Degradation with Long-Term Progression of Joint Damage in Patients with Early Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 46, No. 11, 2002, pp. 2847-2856. doi:10.1002/art.10616
[11] L. Freedman, “Tables of the Number of Patients Required in Clinical Trials Using the Logrank Test,” Statistic in Medicine, Vol. 1, No. 2, 1982, pp. 121-129. doi:10.1002/sim.4780010204
[12] J. Cohen, “A Coefficient of Agreement for Nominal Class,” Educational and Psychological Measurement, Vol. 20, 1960, pp. 37-46. doi:10.1177/001316446002000104
[13] D. Van der Heijde, T. Dankert, F. Nieman, R. Rau and M. Boers, “Reliability and Sensitivity to Change a Simplification of Sharp/Van Der Heijde Radiological Assessment in Rheumatoid Arthritis,” Rheumatology, Vol. 38, No. 10, 1999, pp. 941-947. doi:10.1093/rheumatology/38.10.941
[14] F. A. van Gaalen, S. P. Linn-Rasker, W. T. van Verooij, B. A. de Jong, F. C. Breedveld, C. L. Verweij, et al., “Autoantibodies to Cyclic Citrullinated Peptides Predict Progression to Rheumatoid Arthritis in patients with Un- differentiated Arthritis. A prospective Cohort Study,” Arthritis & Rheumatism, Vol. 50, No. 3, 2004, pp. 709-715. doi:10.1002/art.20044
[15] Charni, F. Juillet and P. Garnero, “Urinary Type II Collagen Helical Peptide (HELIX-II) as a New Biochemical Marker of Cartilage Degradation in Patients with Ostearthritis and Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 52, No. 4, 2005, 1081-1090.
[16] L. Goosec, M. Dougados, P. Goupille, A. Cantagrel, J. Sibilia, O. Meyer, et al., “Prognostics Factor for Remission in Early Rheumatoid Arthritis: A Multiparameter Prospective Study,” Annals of the Rheumatic Diseases, Vol. 63, No. 6, 2004, pp. 675-680. doi:10.1136/ard.2003.010611
[17] G. Schellekens, H. Visser, B. A. W. de Jong, F. H. J. van den Hoogen, J. M. W. Hazes, F. C. Breedveld, et al., “The Diagnostic Properties of Rheumatoid Arthritis Antibodies Recognizing a Cyclic Citrullinated Peptide,” Arthritis & Rheumatism, Vol. 43, No. 1, 2000, pp. 155-163. doi:10.1002/1529-0131(200001)43:1<155::AID-ANR20>3.0.CO;2-3
[18] P. Brennan, B. Harrison, E. Barrett, K.Chakravarty, D. Scott and A. Silma, “A Simple Algorithm to Predict the Early Rheumatoid Arthritis: Prospective Cohrte Study,” British Medical Journal, Vol. 313, 1996, pp. 471-476. doi:10.1136/bmj.313.7055.471
[19] D. van der Heijde, M. A. van Leeuwen, P. L. van Riel, A. M. Koster, M. A. van Hof, M. H. van Rijswijk, et al., “Biannual Radiographic Assessment of Patients with Early Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 35, No. 1, 1992, pp. 26-34. doi:10.1002/art.1780350105
[20] D. Scott and A. Silma, “A Simple Algorithmto Predict the Development of Radiological Erosions in Patients with Early Rheumatoid Arthritis: Prospective Cohort Study,” British Medical Journal, Vol. 313, No. 471, 1996, pp. 471-476.
[21] A. van der Heide, C. Remme, D. Hofman, J. Jacobs and J. Bijlsma, “Prediction of Progression of Radiologic Damage in Newly Diagnosed Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 38, No. 10, 1992, pp. 26-34.
[22] L. M. A. Jansen, I. E. van der Horst-Brwinsma, D. van Schaardenburg, P. D. Bezemer and B. A. C. Dijkmans, “Predictors of Radiographic Joint Damage in Patients with Early Rheumatoid Arthritis,” Annals of the Rheumatic Diseases, Vol. 60, No. 10, 2001, pp. 924-927. doi:10.1136/ard.60.10.924
[23] J. Fries, P. W. Spit, R. G. Kraines and R. H. Holman, “Mea- surement of Patient Outcome in Arthritis,” Arthritis & Rheumatism, Vol. 23, No. 2, 1980, pp. 137-145. doi:10.1002/art.1780230202
[24] A. Finckh, M. H. Liang, C. M. van Herckenrode, et al., “Long-Term Impact of Early Treatment on Radiographic Progression in Rheumatoid Arthritis: A Meta-Analysis,” Arthritis & Rheumatism, Vol. 55, No. 6, 2006, pp. 864-872. doi:10.1002/art.22353
[25] H. Kallberg, L. Padyukov, R. M. Plenge, et al., “Gene-Gene and Gene-Environment Interactions Involving HLA-DRB1, PTPN22, and Smoking in Two Subsets of Rheumatoid Arthritis,” The American Journal of Human Genetics, Vol. 80, No. 5, 2007, pp. 867-875.
[26] L. Klareskog, P. Stolt, K. Lundberg, et al., “A New Model for an Etiology of Rheumatoid Arthritis: Smoking May Trigger HLA-DR (shared epitope)—Restricted Immune Reactions to Autoantigens Modified by Citrullination,” Arthritis & Rheumatism, Vol. 54, No. 1, 2006, pp. 38-46. doi:10.1002/art.21575
[27] M. Pedersen, S. Jacobsen, P. Garred, et al., “Strong Combined Gene-Environment Effects in Anti-Cyclic Citrullinated Peptide-Positive Rheumatoid Arthritis: A Nationwide Case-Control Study in Denmark,” Arthritis & Rheumatism, Vol. 56, No. 5, 2007, pp. 1446-1453. doi:10.1002/art.22597
[28] M. M. Nielen, D. van Schaardenburg, H. W. Reesink, et al., “Specific Autoantibodies Precede the Symptoms of Rheumatoid Arthritis: A Study of Serial Measurements in Blood Donors,” Arthritis & Rheumatism, Vol. 50, No. 2, 2004, pp. 380-386. doi:10.1002/art.20018
[29] S. Rantapaa-Dahlqvist, B. A. de Jong, E. Berglin, et al., “Antibodies against Cyclic Citrullinated Peptide and Arheumatoid Factor Predict the Development of Rheumatoid Arthritis,” Arthritis & Rheumatism, Vol. 48, No. 10, 2003, pp. 2741-2749.
[30] M. K. Koivula, M. Heliovaara, J. Ramberg, et al., “Auto- antibodies Binding to Citrullinated Telopeptide of Type II Collagen and to Cyclic Citrullinated Peptides Predict Synergistically the Development of Seropositive Rheumatoid Arthritis,” Annals of the Rheumatic Diseases, Vol. 66, No. 11, 2007, pp. 1450-1455. doi:10.1136/ard.2006.062919
[31] S. Nijenhuis, A. J. W. Zendman, E. R. Vossenaar, G. J. M. Pruijn, W. J. van Venrooij, “Autoantibodies to Citrullinated Proteins in Rheumatoid Arthritis: Clinical Performance and Biochemical Aspects of an RA-Specific Marker,” Clinica Chimica Acta, Vol. 350, No. 1-2, 2004, pp. 17-34. doi:10.1016/j.cccn.2004.07.016
[32] G. Harauz, N. Ishiyama, C. M. Hill, I. R. Bates, D. S. Libich and C. Fares, “Myelin Basic Protein—Diverse Conformational States of an Intrinsically Unstructured Protein and Its Roles in Myelin Assembly and Multiple Sclerosis,” Micron, Vol. 35, No. 7, 2004, pp. 503-542. doi:10.1016/j.micron.2004.04.005
[33] E. R. Vossenaar, A. J. W. Zendman, W. J. van Venrooij and G. J. M. Pruijn, “PAD, a Growing Family of Citrullinating Enzymes: Genes, Features and Involvement in Disease,” BioEssays, Vol. 25, No. 11, 2003, pp. 1106-1118.

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.