Optimising Outcomes for Patients with Early Inflammatory Arthritis

Background: Early and effective treatment of inflammatory arthritis (IA) is essential to preserve patients’ functional ability and prevent joint damage. Recent strategies for optimising care have included implementing treatment to target management and utilising ultrasound to guide treatment decisions. The 2010 ACR/EULAR rheumatoid arthritis (RA) classification criteria were also recently developed with the aim of facilitating the study of early IA. Aims: To determine the phenotype, management and outcomes of patients with early IA, defined using the 2010 RA criteria, in clinical practice. Specific objectives were to risk stratify patients according to future disease severity, determine their response to treatment and assess the potential utility of ultrasound within a treatment to target strategy. Methods: An audit and a prospective longitudinal observational study were conducted in patients attending the Leeds Early Arthritis Clinic. Patients were classified as undifferentiated arthritis (UA) or RA according to the 2010 RA criteria at baseline. Logistic regression methods were used to identify baseline predictors of outcome and treatment response. Results: Ultrasound detectable synovitis at baseline was independently associated with a higher rate of methotrexate use, persistence of IA and development of new ultrasound erosions at one year in patients with UA and RA, as well as progression from UA to RA in the subset of patients with UA at baseline. A lack of concordance was observed between clinical and ultrasound determined remission in RA patients receiving treatment-to-target management. In this sub-group, objective baseline measures of disease were predictive of imaging remission in comparison to the predominantly subjective parameters, which were predictive of clinical remission. Conclusions: This verifies the value of ultrasound as a prognostic tool in the risk stratification of patients with early IA, over and above the clinical application of the 2010 RA criteria and clinical assessments. It supports future research in the use of ultrasound within a treatment to target strategy.