To our knowledge, no study has specifically assessed seronegative patients in terms of response to treatment. Because seronegative RA is thought to represent a separate entity with presumably different pathogenesis and less severe disease, assessing the differences in response to treatment with seronegative RA would be useful for physicians. Furthermore, the association between the presence of autoantibodies and response to treatment is controversial. The difficulty in reliably diagnosing RA presumably explains the discrepancy between general guidelines and daily practice: although methotrexate (MTX) should be prescribed as soon as RA is diagnosed, it is less often prescribed to “seronegative” patients and mostly as a single treatment. Less is known about the clinical presentation and outcomes of seronegative RA, and studies are disparate given that seronegative RA is more challenging to classify and may indeed represent a heterogeneous population.Įarly and intensive treatment of RA with disease-modifying antirheumatic drugs (DMARDs) is clinically beneficial.
Seropositive RA, particularly ACPA-positive status, is associated with increased likelihood of the development of erosions and further radiographic progression. RF and ACPA status are important for both the diagnosis and prognosis of RA. However in early disease, antibody detection has been reported as low as 50%.
Rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) are the most relevant antibodies associated with RA, and their testing is valuable early in the disease course. Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting about 0.4% of the general population. These findings confirm that the usual therapeutic concepts in RA (early treatment, tight control, and treat-to-target) should be applied similarly to both seropositive and seronegative disease forms. Our results suggest that delay in initiation of csDMARD more than baseline clinical, biological, or imaging features predominantly affects the outcome in early seronegative RA. HAQ-DI ≥ 1 at inclusion and active smoking were significantly associated with HAQ-DI > 0.5 at 1 year. Presence of erosions at baseline was associated with Sharp score progression > 1 point and > 5 points (both p = 0.03) at 1 year. Response rates were not affected by other classical prognostic factors (i.e., baseline DAS28). A good or moderate EULAR response at 1 year was associated with early use of csDMARDs (i.e., within 3 months after the first joint swelling) on univariate and multivariable analysis (odds ratio = 2.41, p = 0.03). Overall, 98/172 (57%) patients received MTX during the first year of follow-up. One hundred seventy-two patients were analyzed. Logistic regression analysis was used to determine independent predictors of outcomes. Secondary objectives were to compare the early therapeutic response to methotrexate (MTX) and leflunomide (LEF) versus other csDMARDs (hydroxychloroquine, sulfasalazine) and to identify factors associated with functional disability (Health Assessment Questionnaire-Disability Index > 0.5 at 1 year) and structural progression (van der Heijde-modified total Sharp score > 1 and > 5 points at 1 year). The primary endpoint was a good or moderate EULAR response assessed after 1 year of follow-up, given at least 3 months of treatment with a csDMARD.
Patients from the ESPOIR cohort with early inflammatory arthritis fulfilling the 2010 ACR/EULAR classification criteria for RA despite negativity for both rheumatoid factor and anti-CCP antibodies. We aimed to determine predictors of good response to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in seronegative RA patients with early inflammatory arthritis.
Little is known about its potentially different initial clinical presentation and outcome. Early seronegative rheumatoid arthritis (RA) is considered a specific entity, especially regarding diagnostic issues and prognosis.
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