Artikel
Follow-Up of Patients with Preclinical Rheumatoid Arthritis – Results of a Telephone Survey
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Veröffentlicht: | 12. September 2014 |
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Background: Preclinical rheumatoid arthritis (pre-RA) describes a subset of patients with arthralgia (but no synovitis) where either anti-citrullinated peptide antibodies (ACPA) and/or rheumatoid factor (RF) can be found, where there was no evidence of clinical RA, and no disease-modifying anti-rheumatic drug (DMARD) therapy was initiated. Recent data indicate that 35% of these patients develop arthritis after 12 months. The objective of this investigation was to follow the course of disease in patients with pre-RA by means of a telephone survey, and evaluate how many patients develop clinical RA.
Methods: In a retrospective analysis, we identified patients (pts) with pre-RA who presented in our early arthritis clinic (EAC). The follow-up questionnaire included questions about tender and swollen joints, overall pain, current antirheumatic therapy, and whether a diagnosis of RA has been established.
Results: 47 pts with pre-RA out of 1,400 pts of our EAC (3.4%) were identified. 23 of these pts (49%) agreed to participate in the telephone survey. 14 (61%) pts were female. The mean age was 54 (standard deviation (SD) ± 15) years. Mean duration between first contact in EAC and follow-up was 6 (SD ± 2) years.
When asked about the course of their symptoms including joint pain and joint swelling, 5 pts (22%) stated that they were now free of complaints, in 10 pts (44%) complaints were improved, in 5 (22%) they were unchanged, in 3 (13%) they had reappeared, and in none of the pts (0%) had complaints deteriorated.
3 pts (13%) developed clinical RA after a duration of 1, 3, and 6 years, respectively. These 3 pts are currently taking DMARD therapy (2 Methotrexate, 1 Leflunomide).
Conclusion: The overall risk of developing clinical RA in this cohort of pre-RA pts was low (13%). Serum levels of RF or ACPA were not predictive for the development of RA, and neither was double positive antibody status associated with a higher risk for RA. Large prospective cohorts are needed to confirm these findings.