Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Local Swelling and Prolonged Local Pain in a Large Joint Are Independent Predictors of Damage in That Joint in Recent Onset Rheumatoid Arthritis Patients.

van den Broek1,  M., Dirven1,  L., Kroon1,  H.M., van Oosterhout2,  M., Han3,  K.H., Kerstens4,  P.J.S.M., Huizinga1,  Tom W.J.

Leiden University Medical Center, Leiden, Netherlands
Groene Hart Hospital, Gouda, Netherlands
Maasstad Hospital, Rotterdam, Netherlands
Jan van Breemen Research Institute Reade, Amsterdam, Netherlands
VU University medical center, Amsterdam, Netherlands


To assess the association between local swelling and pain in the large joints in the first 2 years after diagnosis of RA with radiological damage in these joints after 8 years.


Two-year clinical data and 8-year radiological data from the BeSt study, a randomized controlled trial designed to assess 4 different treatment strategies, were used. Two-year clinical data were chosen because disease activity was highest in these years and clinical symptoms were unlikely to be caused by large joint damage. Patients were treated according to a disease activity steered protocol. Radiographs were scored by an experienced radiologist (HK) using the Larsen score (ranging from 0–5 in each joint). Swelling and pain in these joints were assessed 3-monthly, with exception of swelling in the hips. The association between swelling and pain in each large joint (at least once, or prolonged, i.e. at least 2 consecutive visits) and joint damage in this joint was assessed using generalized estimating equations. Swelling (model 1), pain (model 2) and swelling and pain (model 3) were entered as predictors, adjusted for baseline age, ESR, and body mass index (BMI), gender and time-averaged DAS, treatment strategy, rheumatoid factor (RF) or anti-citrullinated protein antibodies (ACPA), or a combination of these variables. Large joint damage (yes/no) was the outcome measure.


Clinical and radiological data were available in 290 patients. Joint damage was observed in 64/532 (12%) shoulders, 51/538 (9.5%) elbows, 141/541 (26%) wrists, 67/521 (13%) hips, 95/528 (18%) knees and 39/544 (7%) ankles. Damage in at least 1 large joint was found in 64% of patients. Local pain and swelling in the first 2 years after diagnosis were most often observed in the wrists and ankles. Local swelling at least once in the first 2 years was independently associated with joint damage of the large joints, with an odds ratio (OR) of 1.8 (95% C.I. 1.3–2.3) (Table 1). Prolonged swelling and prolonged pain were both independent predictors of local joint damage, with an OR of 2.5 (95% C.I. 1.8–3.4) for prolonged swelling and of 1.4 (95% C.I. 1.05–1.9) for prolonged pain. Other independent predictors were baseline ESR (OR 1.01, 95%C.I. 1.001–1.02) and the presence of RF or ACPA (OR 2.2, 95% C.I. 1.3–3.8), or a combination of these two (OR 2.4, 95% C.I. 1.5–4.0).

Table 1. The association between local swelling, pain or swelling and pain with joint damage.

  At least onceAt least 2 consecutive
Model 1Swelling2.0 (1.5–2.6)2.9 (2.1–3.9)
Model 2Pain1.7 (1.2–2.2)1.9 (1.4–2.5) Model 3Swelling1.8 (1.3–2.3)2.5 (1.8–3.4)
Pain1.4 (0.99–1.9)1.4 (1.05–1.9) 


Local swelling and prolonged local pain in a large joint in the first 2 years after diagnosis of RA are independent predictors of later joint damage in that joint. These results suggest that local control of inflammation might be beneficial to prevent damage.

To cite this abstract, please use the following information:
van den Broek, M., Dirven, L., Kroon, H.M., van Oosterhout, M., Han, K.H., Kerstens, P.J.S.M., et al; Local Swelling and Prolonged Local Pain in a Large Joint Are Independent Predictors of Damage in That Joint in Recent Onset Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :354

Abstract Supplement

Meeting Menu