Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Review article: Biomedical intelligence

Vol. 140 No. 3738 (2010)

Prognostic evaluation of early rheumatoid arthritis

  • Mota da
  • IM Laurindo
  • Carvalho de
  • Santos-Neto dos
DOI
https://doi.org/10.4414/smw.2010.13100
Cite this as:
Swiss Med Wkly. 2010;140:w13100
Published
13.09.2010

Summary

The progression of rheumatoid arthritis (RA) is quite variable, ranging from very mild or subclinical forms (approx. 10%) to rapidly progressing and debilitating forms (10–15%). The majority of patients present with an intermediate stage with episodes of exacerbation separated by periods of relative inactivity, which evolves to progressive functional losses. To optimise the therapeutic management of early RA it is necessary to perform periodic evaluations of the clinical and laboratory test responses to the treatment instituted, as well as the parameters indicating disease prognosis. Composite measures are frequently used to evaluate the disease activity score (DAS), including the response criteria of the American College of Rheumatology (ACR), the response criteria and the DAS according to the European League Against Rheumatism (EULAR) and the composite indices of disease activity (CIDsA): DAS, the index of disease activity based on 28 joints (DAS 28), the simplified disease activity index (SDAI) and the clinical disease activity index (CDAI). The evaluation of prognosis includes investigation of the absence or occurrence of disease and joint damage remission. Due to the multifaceted nature of RA, no single clinical or laboratory parameter is able to describe satisfactorily the level of inflammatory activity or the disease prognosis at any given time.

References

  1. Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet. 2001;358:903–11.
  2. Scott DL, Smith C, Kingsley G. What are the consequences of early rheumatoid arthritis for the individual? Best Pract Res Clin Rheumatol. 2005;19:117–36.
  3. Allaire S, Wolfe F, Niu J, Lavalley MP, Zhang B, Reisine S. Current risk factors for work disability associated with rheumatoid arthritis: Recent data from a US national cohort. Arthritis Rheum. 2009;61321–8.
  4. Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O’Fallon WM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48:54–8.
  5. Gonzalez A, Maradit Kremers H, Crowson CS, Nicola PJ, Davis JM 3rd, Therneau TM, et al. The widening mortality gap between rheumatoid arthritis patients and the general population. Arthritis Rheum. 2007;56:3583–7.
  6. Sokka T, Abelson B, Pincus T. Mortality in rheumatoid arthritis: 2008 update. Clin Exp Rheumatol. 2008;26:S35–61.
  7. Gonzalez A, Icen M, Kremers HM, Crowson CS, Davis JM 3rd, Therneau TM, et al. Mortality trends in rheumatoid arthritis: the role of rheumatoid factor. J Rheumatol. 2008;35:945–9.
  8. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46:328–46.
  9. Pinheiro GRC. Instrumentos de medida da atividade da artrite reumatóide – por que e como empregá-los. Rev Bras Reumatol. 2007;47:362–5.
  10. Scott DL. Early rheumatoid arthritis. Br Med Bull. 2007;81:97–114.
  11. Felson DT, Anderson JJ, Boers M, Bombartdier C, Furst D, Goldsmith C, et al. American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995;38:727–35.
  12. van der Heidjde DMFM, vant Hof MA, van Riel PLCM, van de Putte LBA. Development of a disease activity score based on judgment in clinical practice by rheumatologists. J Rheumatol. 1993;20:579–81.
  13. van der Heijde DMFM, van’t Hof MA, van Riel PLCM, Theunisse HAM, Lubberts EW, van Leeuwen MA, et al. Judging disease activity in clinical practice in rheumatoid arthritis. First step in the development of a “disease activity score”. Ann Rheum Dis. 1990;49:916–20.
  14. Prevoo MLL, van´T Hof MA, Kuper HH, van Leewen MA, van de Putte, van Riel PLC. Modified disease activity scores that include twenty-eight-joint counts. development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44–8.
  15. Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G. A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology. 2003;42:244–5.
  16. Aletaha D, Smolen JS. The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): A review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005;23:S100–8.
  17. Bértolo MB, Brenol CV, Schainberg CG, Neubarth F, Lima FAC, Laurindo IM, et al. Atualização do consenso brasileiro no diagnóstico e tratamento da artrite reumatóide. Rev Bras Reumatol. 2007;47:151–9.
  18. Salaffi F, Peroni M, Ferraccioli GF. Discriminating ability of composite indices for measuring disease activity in rheumatoid arthritis: a comparison of the Chronic Arthritis Systemic Index, Disease Activity Score and Thompson’s articular index. Rheumatology. 2000;39:90–6.
  19. Smolen JS, Aletaha D. Activity assessment in rheumatoid arthritis. Curr Opin Rheumatol. 2008;20:306–13.
  20. Dougados M, Aletaha D, van Riel. Disease activity measures for rheumatoid arthritis. Clin Exp Rheumatol. 2007;25:S22–9.
  21. Emery P, Breedveld FC, Dougados M, Kalden JR, Schiff MH, Smolen JS. Early referral recommendations for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis. 2002;61:290–7.
  22. Welsing PM, van Gestel AM, Swinkels HL, Kiemeney LALM, van Riel PLCM. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001;44:2009–17.
  23. Machold KP, Nell VP, Stamm TA, Eberl G, Steiner G, Smolen JS. The Austrian early arthritis registry. Clin Exp Rheumatol. 2003;21:S113–7.
  24. Wiles N, Dunn G, Barrett E, Silman A, Symmons D. Associations between demographic and disease-related variables and disability over the first five years of inflammatory polyarthritis: a longitudinal analysis using generalized estimating equations. J Clin Epidemiol. 2000;53:988–96.
  25. Nell VPK, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology. 2004;43:906–14.
  26. Sokka T, Envalds M, Pincus T. Treatment of rheumatoid arthritis: a global perspective on the use of antirheumatic drugs. Mod Rheumatol. 2008;18:228–39.
  27. Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum. 1981;24:1308–15.
  28. Smolen JS, Aletaha D. Activity assessments in rheumatoid arthritis. Curr Opin Rheumatol. 2008;20:306–13.
  29. Smolen J, Aletaha D. The burden of rheumatoid arthritis and access to treatment: a medical overview. Eur J Health Econ. 2008;8:S39–47.
  30. Cush JJ. Early rheumatoid arthritis- is there a window of opportunity? J Rheumatol Suppl. 2007;80:1–7.
  31. Wolfe F, Hawley DJ. Remission in rheumatoid arthritis. J Rheumatol. 1985;12:245–52.
  32. Eberhardt K, Fex E. Clinical course and remission rate in patients with early rheumatoid arthritis: relationship to outcome after 5 years. Br J Rheumatol. 1998;37:1324–9.
  33. Prevoo ML, van Gestel AM, van T Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Remission in a prospective study of patients with rheumatoid arthritis. American Rheumatism Association preliminary remission criteria in relation to the disease activity score. Br J Rheumatol. 1996;35:1101–5.
  34. Möttönen T, Paimela L, Ahonen J, Helve T, Hannonen P, Leirisalo-Repo M. Outcome in patients with early rheumatoid arthritis treated according to the “sawtooth” strategy. Arthritis Rheum. 1996;39:996–1005.
  35. Sokka T, Hannonen P. Utility of disease modifying antirheumatic drugs in “sawtooth” strategy. A prospective study of early rheumatoid arthritis patients up to 15 years. Ann Rheum Dis. 1999;58:618–22.
  36. Harrison B, Symmons D. Early inflammatory polyarthritis: results from the Norfolk Arthritis Register with a review of the literature II. Outcome at three years. Rheumatology. (Oxford) 2000;39:939–49.
  37. Young A, Dixey J, Cox N, Davies P, Emery P, Gallivan S. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS). Rheumatology. (Oxford) 2000;39:603–11.
  38. Lindqvist E, Saxne T, Geborek K, Eberhardt K. Ten year outcome in a cohort of patients with early rheumatoid arthritis: health status, disease process, and damage. Ann Rheum Dis. 2002;61:1055–9.
  39. Visser H, le Cessie S, Vos K, Breedveld FC, Hazes JM, How to diagnose rheumatoid arthritis early. A prediction model for persistent (erosive) arthritis, Arthritis Rheum. 2002;46:357–65.
  40. Schumacher Jr. HR, Habre W, Meador R, Hsia EC. Predictive factors in early rheumatoid arthritis: long term follow-up. Semin Arthritis Rheum. 2004;33:264–72.
  41. Tengstrand B, Ahmen M, Hafsrom I. The influence of sex on rheumatoid arthritis: a prospective study of onset and outcome after 2 years. J Rheumatol. 2004;31:214–22.
  42. Vázquez I, Graell E, Gratacós J, Cañete JD, Viñas O, Ercilla MG, et al. Prognostic markers of clinical remission in early rheumatoid arthritis after two years of DMARDs in a clinical setting. Clin Exp Rheumatol. 2007;25:231–8.
  43. Forslind K, Hafström I, Ahlmén M, Svensson B; the BARFOT Study Group. Sex: a major predictor of remission in early rheumatoid arthritis. Ann Rheum Dis. 2007;6646–52.
  44. Pascual-Ramos V, Contreras-Yáñez I, Villa RA, Cabiedes J, Rull-Gabayet M. Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability. Arthritis Res Ther. 2009;11R26.
  45. Verschueren P, Esselens G, Westhovens R. Predictors of remission, normalized physical function, and changes in the working situation during follow-up of patients with early rheumatoid arthritis: an observational study. Scand J Rheumatol. 2009;23:1–7.
  46. Ikeda K, Cox S, Emery P. Aspects of early arthritis. Biological therapy in early arthritis-overtreatment or the way to go? Arthritis Res Ther. 2007;9:211.
  47. Brook A, Corbett M. Radiographic changes in early RA. Ann Rheum Dis. 1977;36:71–3.
  48. Scott DL, Smith C, Kingsley G. Joint damage and disability in rheumatoid arthritis: an updated systematic review. Clin Exp Rheumatol. 2003; 21:S20–7.
  49. Machold KP, Stamm TA, Eberl GJ, Nell VK, Dunky A, Uffmann M, et al. Very recent onset arthritis – clinical, laboratory, and radiological findings during the first year of disease. J Rheumatol. 2002;29:2258–60.
  50. Dixey J, Solymossy C, Young A. Early RA Study, Is it possible to predict radiological damage in early rheumatoid arthritis (RA)? A report on the occurrence, progression, and prognostic factors of radiological erosions over the first 3 years in 866 patients from the Early RA Study (ERAS). J Rheumatol Suppl. 2004;69:48–54.
  51. Combe B, Landewe R, Lukas C, Bolosiu HD, Breedvelt F, Dougados M, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:34–45.
  52. Ostergaard M, Dohn UM, Ejbjerg BJ, McQueen FM. Ultrasonography and magnetic resonance imaging in early rheumatoid arthritis: recent advances. Curr Rheumatol Rep. 2006; 8:378–85.
  53. Tugwell P, Idzerda L, Wells GA. Generic quality-of-life assessment in rheumatoid arthritis. Am J Manag Care. 2008;14(4):234.; Tugwell P, Idzerda L, Wells GA. Generic quality-of-life assessment in rheumatoid arthritis. Am J Manag Care. 2007;13:S224–36.