Predictors of radiographic progression in the ESPOIR cohort: the season of first symptoms may influence the short-term outcome in early arthritis.

Mouterde G, Lukas C, Logeart I, Flipo RM, Rincheval N, Daurès JP, Combe B.

Source

Rheumatology Department, Montpellier 1 University, Lapeyronie Hospital, France. b-combe@chu-montpellier.fr

Abstract

OBJECTIVES:

To determine predictors of short-term radiographic progression in an inception cohort of patients with early arthritis.

METHODS:

Patients presenting with synovitis of at least two joints for 6 weeks to 6 months were included in the Etude et Suivi des POlyarthrites Indifferenciées Récentes (ESPOIR) cohort. Univariate analysis was used to determine the relationship between baseline variables and radiographic outcome (assessed by the modified total Sharp score (mTSS)) after 6 and 12 months. Stepwise multiple logistic regression was used to select independent predictive factors. The sensitivity and specificity of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) at baseline in discriminating between erosive and non-erosive disease were determined by receiver operating characteristic (ROC) curves.

RESULTS:

From data available for 736 patients, radiographic progression at 6 months was independently predicted by baseline ACPA, human leucocyte antigen (HLA)-DRB1*01 and/or 04 genes, erythrocyte sedimentation rate and mTSS. Interestingly, the season of onset of the first symptoms was associated with the severity of early arthritis (OR 1.66, 95% CI 1.07 to 2.59, in winter and spring vs summer and autumn). Univariate analysis revealed similar results for season at 12 months (OR 1.68, 95% CI 1.20 to 2.37). The peak of the ROC curves for radiographic outcome occurred with ACPA and RF values similar to the cut-offs provided by manufacturers.

CONCLUSION:

The authors found the onset of arthritis symptoms during winter or spring associated with greater radiographic progression at 6 months for patients with early arthritis. These data could reinforce the role of environmental factors in the development and outcome of rheumatoid arthritis.

PMID: 21515603

分析早期关节炎队列发现冬春季发病者的短期放射学进展更重

Mouterde G, et al. Ann Rheum Dis.2011;70:1251-6.

背景: 基于一个早期关节炎起始队列研究，探究短期放射学进展的预测因素。

方法: ESPOIR(一个早期关节炎队列)纳入条件为≥2个炎性关节且症状持续6周至6个月。利用单变量分析研究基线参数值与6至12月后放射学结局(用改良Sharp总评分(mTSS)之间的关联性。利用逐步多元逻辑回归分析独立预测因素。利用接收者工作曲线特征分析基线时类风湿因子(RF)和抗CCP抗体(ACPA)对于鉴别侵蚀性和非侵蚀性病变的敏感性和特异性。

结果: 共736例RA病人可获得数据。6个月时放射学进展可由以下基线参数值分别独立地预测：ACPA，人HLA-DRB1*01和/或04基因型，ESR以及mTSS。有趣的是，首发症状的发生季节与早期关节炎严重度相关联(冬春季与夏秋季相比的OR值为1.66, 95%CI: 1.07 - 2.59)。单变量分析得到有关发病季节的相似结果(OR: 1.68, 95%CI: 1.20 - 2.37)。有关放射学结局的ROC分析发现与相应峰值对应的ACPA和RF数值与检验试剂厂商所提供的分界值(cut-off)相似。

结论: 研究者发现冬季或春季发病与病程6个月时早期关节炎放射学进展的相关度较高。这些数据进一步增强了环境因素在RA发生和演变中的重要作用。