Email updates

Keep up to date with the latest news and content from Arthritis Research & Therapy and BioMed Central.

Open Access Research article

The prognostic value of baseline erosions in undifferentiated arthritis

Mohamed M Thabet12*, Thomas WJ Huizinga1, Désirée M van der Heijde1 and Annette HM van der Helm-van Mil1

Author Affiliations

1 Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, Leiden, PO Box 9600, 2300RC, The Netherlands

2 Department of Internal Medicine, Assiut University Hospital, University Street 1, Assiut, P.O. Box 71515, Egypt

For all author emails, please log on.

Arthritis Research & Therapy 2009, 11:R155  doi:10.1186/ar2832

Published: 15 October 2009

Abstract

Introduction

Undifferentiated arthritis (UA) has a variable disease course; 40 to 50% of UA patients remit spontaneously, while 30% develop rheumatoid arthritis (RA). Identifying the UA patients who will develop RA is essential to initiate early disease-modifying anti-rheumatic drug (DMARD) therapy. Although the presence of bone erosions at baseline is predictive for a severe destructive disease course in RA, the prognostic importance of erosive joints for disease outcome in UA is unknown. This study evaluates the predictive value of erosive joints for the disease outcome in UA as measured by RA development and disease persistency.

Methods

Baseline hands and feet radiographs of 518 UA patients were evaluated for erosions using a clinical definition as well as the Sharp/van der Heijde method. After 1 year follow-up, patients were re-assessed for the fulfilment of the 1987 ACR classification criteria for RA. Disease persistency was defined as the absence of sustained remission during all available follow-up (mean 8 ± 3 years).

Results

At baseline, 28.6% of UA patients had erosive joints. Presence of ≥2 erosive joints showed a positive predictive value for RA development of 53% and for persistent disease of 68%. Patients with erosions that did not develop RA were less often anticyclic citrullinated peptide antibody (ACPA)+ve, rheumatoid factor (RF)+ve and had lower C-reactive protein (CRP), erythrocytic sedimentation rate (ESR) and number of swollen joints compared to those who developed RA. Feet erosions are equally predictive compared to erosions at hands.

Conclusions

Presence of ≥2 erosive joints at baseline in UA patients gives a risk for RA development of 53% and for persistent disease of 68%, indicating that erosions in UA are not always predictive for unfavorable disease outcomes.