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Positive anti-citrullinated protein antibody status and small joint arthritis are consistent predictors of chronic disease in patients with very early arthritis: results from the NOR-VEAC cohort
Arthritis Research & Therapy, 10/02/09

Mjaavatten MD et al. – Positive ACPA status and small joint arthritis were consistent predictors of three relevant outcomes of chronic arthritis in very early arthritis patients. This consistency supports DMARD prescription as a valid surrogate endpoint for chronic arthritis. Importantly, this surrogate is used in ongoing efforts to develop new diagnostic criteria for early RA.

Methods

Norwegian Very Early Arthritis Cohort (NOR-VEAC) includes adult patients with at least 1 swollen joint of [less than or equal to] 16 weeks duration
Patients followed for 2 years with comprehensive clinical and laboratory examinations
Logistic regression analyses performed to determine independent predictors of 3 outcomes: persistent synovitis, prescription of disease-modifying anti-rheumatic drugs (DMARDs), and established clinical RA diagnosis within 1 year

Results

Of 384 patients eligible for 1 year follow-up (56.3% females, mean (SD) age 45.8 (14.7) years, median (IQR) duration of arthritis 31 (10-62) days), 14.4% were anti-CCP2 positive, and 11.2% were IgM RF positive
98 patients had persistent synovitis, 106 had received DMARD treatment during follow-up, while 68 (17.7%) were diagnosed with RA
Consistent independent predictors across all 3 outcomes were positive anti-citrullinated protein antibody (ACPA) status (odds ratio (OR) 3.2, 5.6 and 19.3), respectively, and small joint arthritis (proximal interphalangeal joint (PIP), metocarpo-phalangeal joint (MCP), and/or metotarso-phalangeal joint (MTP) joint swelling) (OR 1.9, 3.5, and 3.5

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