Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Prognostic Value of Patient History, Radiography and Serology On Poor Outcomes in Undifferentiated Inflammatory Arthritis Patients

Petre1,  Maria A., Cheng1,  Carly K., Boire2,  Gilles, Pope3,  J., Haraoui4,  Boulos, Hitchon5,  Carol A., Jamal6,  Shahin

Mt 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,
Southlake Regional Health Centre, Newmarket, ON

Purpose:

To determine the clinical outcome of undifferentiated inflammatory arthritis (UIA) patients enrolled in 2 Canadian early arthritis cohorts and the prognostic value of patient history, physical exam, serology, and radiography for poor patient outcomes.

Methods:

Data from patients (n=643) enrolled since Sept. 2003 were collected from the Toronto/Canadian Early Arthritis Cohorts (TEACH/CATCH). CATCH is a multi-centre observational prospective "real world" cohort of patients with early inflammatory arthritis (EIA). Inclusion criteria: age >16, symptom duration of 6–52 weeks of persistent synovitis, >=2 effused joints or 1 swollen MCP/PIP +>=1 of: + RF, + anti-CCP, AM stiffness >45 minutes, response to NSAIDs, or painful MTP squeeze test. UIA was defined as not meeting 1987 ACR classification criteria for rheumatoid arthritis (RA) or criteria for other rheumatological diagnoses. The proportion of patients developing a classifiable diagnosis over time (survival analysis) and hazard ratios (HR) for the prognostic value of baseline age, gender, smoking status, initial use of DMARDs, RF status, 2nd-5th MTP involvement (including erosions), in the progression of UIA to RA were calculated. The feet were evaluated in this study due to their under-representation in the current ACR criteria for RA diagnosis.

Results:

Baseline (BL) characteristics of UIA patients were: mean age 51±15 years, 75% female, median symptom duration 6.1 months, and mean DAS28 3.5±1.9. Of all the patients completing the study to 1 year (n=229), 23.1% were UIA at baseline (n=53). Of those who were UIA at baseline, 64.1% remained UIA at 12 months, while 35.8% developed RA. HRs are given in Table 1.

Predictors for progression of UIA to rheumatoid arthritis (RA)

 Hazard Ratio (to RA by ACR Criteria)Confidence Interval
Age (>65)0.9950.961–1.029
Female Gender1.0110.339–3.013
Smoking1.5260.403–5.777
DMARD0.9190.343–2.461
RF0.1470.019–1.157
2-5 MTP tenderness1.1111.001–1.233
2-5 MTP swelling0.9040.801–1.019
Foot erosions4.4281.231–15.930

Conclusion:

Early presence of MTP tenderness and erosions predicted which patients will develop RA, not accounting for anti-CCP status. Smoking was not predictive. Further analyses on the role of anti-CCP are planned.

To cite this abstract, please use the following information:
Petre, Maria A., Cheng, Carly K., Boire, Gilles, Pope, J., Haraoui, Boulos, Hitchon, Carol A., et al; Prognostic Value of Patient History, Radiography and Serology On Poor Outcomes in Undifferentiated Inflammatory Arthritis Patients [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1191
DOI: 10.1002/art.26265

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