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The prognostic value of baseline erosions in undifferentiated arthritis
Arthritis Research & Therapy, 10/19/09

Thabet MM et al. – Undifferentiated arthritis (UA) has a variable disease course; 40 to 50% of UA patients remit spontaneously, while 30% develop rheumatoid arthritis (RA). This study evaluates the predictive value of erosive joints for the disease outcome in UA as measured by RA development and disease persistency. Presence of ≥ 2 erosive joints at baseline in UA patients gives a risk for RA development of 53% and for persistent disease of 68%, indicating that erosions in UA are not always predictive for unfavorable disease outcomes.

Methods

Baseline hands and feet radiographs of 518 UA patients evaluated for erosions using clinical definition as well as Sharp/van der Heijde method
After 1 year follow-up, patients re-assessed for fulfilment of 1987 ACR classification criteria for RA
Disease persistency defined as absence of sustained remission during all available follow-up (mean 8 +/- 3 years)

Results

At baseline, 28.6% of UA patients had erosive joints
Presence of ≥ 2 erosive joints showed positive predictive value for RA development of 53% and persistent disease of 68%
Patients with erosions that did not develop RA were less often anticyclic citrullinated peptide antibody (ACPA)+ve, rheumatoid factor (RF)+ve and had lower CRP, ESR and number of swollen joints compared to those who developed RA
Feet erosions are equally predictive compared to erosions at hands