Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
The Clinical Course, Outcomes, and Treatment of Early Inflammatory Arthritis: Results From CATCH (Canadian Early Arthritis Cohort)
Katchamart1, W., Boire2, Gilles, Pope3, Janet, Haraoui4, C., Hitchon5, Carol A., Jamal6, Shahin, Thorne7, Jc
Mount Sinai Hospital, Toronto, ON
Centre hospitalier universitaire de Sherbrooke, Sherbrooke
St Joseph Health Care, London, ON
Institut de Rhumatolgie de Montreal, Montreal, QC
University of Manitoba, Winnipeg, MB
St. Michael's Hospital, Toronto
Mt Sinai Hospital, Toronto, ON
To investigate the clinical course, outcomes, and treatments of early inflammatory arthritis (EIA) over time comparing between patients in different disease activity states at presentation
Patients were recruited to CATCH, a Canadian, multicenter, prospective, observational study of EIA, according to these criteria: >16 years old, symptoms for 652 weeks, and >=2 swollen joints or 1 swollen MCP/PIP joint and >=1 of: + rheumatoid factor, anti-CCP, morning stiffness > 45 min, a response to NSAIDs, or painful MTP joint squeeze test. Treatment consisted of initial DMARDs based on patient and rheumatologist' discretion to reach a goal of remission. Patients were assessed at baseline, every 3 months for 1st year and every 6 months thereafter. Patients were eligible in this analysis if they had completed DAS28 data at baseline and one year of follow-up.
A total of 234 patients had completed one year of follow-up. At baseline, the proportion of patients who had high (HAD), moderate (MDA), low disease activity (LDA) and were in remission was 52%(121), 35%(83), 6%(15), and 6%(15), respectively. Patients with HAD, MDA, and LDA significantly improved over the time of follow up (p<0.0001), while patients presenting with remission had an increased mean disease activity over 1-year of follow-up (mean change of DAS28 ± SD at 3 month 0.5 ± 0.55, 6 month 0.35 ± 1.03, 9 month 0.23 ± 0.73, and 1 year 0.12 ± 0.94 with p <0.0001). Patients with baseline LDA (20%) and remission (33%) had a significant higher proportion of clinical progression compared to patients presenting with HAD (2%) or MDA (12%). Patients presenting with remission significantly received less aggressive treatments with MTX, parenteral MTX, and DMARD combinations. They also received a delayed MTX treatment compared to HDA group (53% vs.16%, p 0.006).
In this early arthritis cohort, a significant number of patients presented with very low disease activity. One-third had progressive disease within 1 year despite DMARD treatment. Patients with mild inflammatory arthritis who have a poor prognosis need to be identified early so that more aggressive treatment can be started at the outset.
To cite this abstract, please use the following information:
Katchamart, W., Boire, Gilles, Pope, Janet, Haraoui, C., Hitchon, Carol A., Jamal, Shahin, et al; The Clinical Course, Outcomes, and Treatment of Early Inflammatory Arthritis: Results From CATCH (Canadian Early Arthritis Cohort) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :369