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Five-year favorable outcome of patients with early rheumatoid arthritis in the 2000s: data from the ESPOIR cohort.

Bernard Combe 1, 2 Nathalie Rincheval Joelle Benessiano 3 Francis Berenbaum 4 Alain Cantagrel 5 Jean-Pierre Daurès 2 Maxime Dougados 6 Patrice Fardellone 7 Bruno Fautrel 8 Rene M Flipo Philippe Goupille 9 Francis Guillemin 10, 11 Xavier Le Loët 12 Isabelle Logeart 13 Xavier Mariette 14 Olivier Meyer 15 Philippe Ravaud 16 Alain Saraux 17, 18 Thierry Schaeverbeke 19 Jean Sibilia 20 
Abstract : OBJECTIVE: To report the 5-year outcome of a large prospective cohort of patients with very early rheumatoid arthritis (RA), and to identify factors predictive of outcome. METHODS: Patients were recruited if they had early arthritis of < 6 months' duration, had a high probability of developing RA, and had never been prescribed disease-modifying antirheumatic drugs (DMARD) or steroids. Logistic regression analysis was used to determine factors that predict outcome. RESULTS: We included 813 patients from December 2002 to April 2005. Age was 48.1 ± 12.6 years, delay before referral 103.1 ± 52.4 days, 28-joint Disease Activity Score (DAS28) 5.1 ± 1.3, Health Assessment Questionnaire (HAQ) 1.0 ± 0.7; 45.8% and 38.7% had rheumatoid factor or antibodies to cyclic citrullinated peptide (anti-CCP), respectively; 22% had hand or foot erosions; 78.5% fulfilled the American College of Rheumatology/European League Against Rheumatism criteria for RA at baseline and 93.8% during followup. At 5 years, 573 patients were evaluated. The outcome was mild for most patients: disease activity (median DAS28 = 2.5) and HAQ disability (median 0.3) were well controlled over time; 50.6% achieved DAS28 remission and 64.7% low disease activity. Radiographic progression was low (2.9 Sharp unit/year) and only a few patients required joint surgery. Nevertheless, some patients developed new comorbidities. During the 5 years, 82.7% of patients had received at least 1 DMARD (methotrexate, 65.9%), 18.3% a biological DMARD, and about 60% prednisone at least once. Anti-CCP was the best predictor of remaining in the cohort for 5 years, of prescription of synthetic or biologic DMARD, and of radiographic progression. CONCLUSION: The 5-year outcome of an early RA cohort in the 2000s was described. Anti-CCP was a robust predictor of outcome. The generally good 5-year outcome could be related to early referral and early effective treatment, key processes in the management of early RA in daily practice.
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Submitted on : Monday, January 20, 2014 - 11:54:30 AM
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Bernard Combe, Nathalie Rincheval, Joelle Benessiano, Francis Berenbaum, Alain Cantagrel, et al.. Five-year favorable outcome of patients with early rheumatoid arthritis in the 2000s: data from the ESPOIR cohort.. Journal of Rheumatology, 2013, 40 (10), pp.1650-7. ⟨10.3899/jrheum.121515⟩. ⟨hal-00933273⟩



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