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Chronic Inflammatory Rheumatic Disease Common in Monoarthritis
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Among patients with recent-onset arthritis, roughly one-fourth develop chronic inflammatory rheumatic disease after 2 years, according to findings.
In the study, researchers identified 347 patients enrolled in the Norwegian Very Early Arthritis Clinic (NOR-VEAC) who had monoarthritis. NOR-VEAC is a 2-year prospective, multicenter, observational cohort of 1,118 patients aged 18 to 75 years with clinically evident arthritis in at least one joint of 16 weeks’ duration or less between 2004 and 2010.
Rheumatologists and study nurses collected data at baseline and after 3, 6, 12 and 36 months. Patients provided self-reported health status by questionnaires.
The present study included patients with any follow-up data. The treating rheumatologist determined the final clinical diagnoses, and these diagnoses were coded according to WHO ICD. Patients were included in the chronic inflammatory rheumatic disease (CIRD) group if they had diagnoses of rheumatoid arthritis, psoriatic arthritis, other chronic spondyloarthritis and connective tissue disease. Additionally, patients with undifferentiated arthritis or reactive arthritis were placed in the CIRD group if they used disease-modifying antirheumatic drugs during follow-up, had persistent joint swelling or used glucocorticoids during the last 3 months of follow-up. A non-CIRD group included patients in whom the arthritis was resolved without DMARDs. Patients with gout or degenerative disorders during follow-up were also assigned to the CIRD group.
The researchers compared baseline patient characteristics between CIRD and non-CIRD patients using chi-square test, independent sample t test or Mann-Whitney-Wilcoxon test. They also conducted multivariable logistic regression analyses, with CIRD as the dependent variable.
The researchers found that CIRD did not develop in most (73.8%) patients. The CIRD group (n = 91) consisted of 21 patients with RA (6.1%) 16 patients with PsA (4.6%), 13 with other chronic SpA (3.5%) and 41 with persistent undifferentiated arthritis (12.1%).
Because ankle and wrist involvement were both linked univariably to the study outcome, the researchers employed a categorical variable comparing ankle, wrist and other joints for the multivariate regression analysis. Monoarthritis of the wrist had an OR of 2 (95% CI, 1-4.2) for CIRD, whereas monoarthritis of the ankle had an OR of 0.5 (95% CI, 0.3-1.2) when compared with all other joints.
The lowest rate of CIRD (10.3%) was seen in patients with ankle monoarthritis (n = 58), and none of these patients developed RA or PsA
“Monoarthritis is common in patients with very early arthritis,” the researchers wrote. “Our study further demonstrated that approximately one-fourth of recent-onset monoarthritis patients developed CIRD over 2 years. The results facilitate early identification of monoarthritis.” – by Jennifer Byrne
Disclosures: One author reports receiving speaking and/or consulting fees from AbbVie, Biogen, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Epirus, Janssen, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Hospira/Pfizer, Roche, Sandoz and UCB. Please see the study for all other authors’ relevant financial disclosures.
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Norli ES, et al. Arthritis Care Res. 2017;doi:10.1002/acr.23334.
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