Related Experiment Video
Updated: Aug 14, 2026
Measuring Psoriasis Severity at Home
Published on: March 1, 2024
Databases of patients with early rheumatoid arthritis in the USA
T Sokka1, J Willoughby, Y Yazici
1Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Early rheumatoid arthritis (RA) patient databases reveal disease heterogeneity. Progressive RA is predicted by joint swelling, while active joints impact function more than RA classification.
Area of Science:
- Rheumatology
- Clinical Epidemiology
- Patient Registries
Background:
- Early rheumatoid arthritis (RA) diagnosis and management are critical for long-term outcomes.
- Several US-based patient cohorts have been established to study early RA.
- Understanding disease progression and predictors is essential for effective treatment strategies.
Purpose of the Study:
- To review findings from various early rheumatoid arthritis (RA) cohorts in the USA.
- To identify predictors of disease progression and functional outcomes in early RA.
- To assess the impact of early treatment interventions on RA patient trajectories.
Main Methods:
- Analysis of data from multiple established early RA cohorts: University of Tennessee at Memphis, NIH, Western Consortium of Practicing Rheumatologists (CPR), SONORA, CLEAR, and ERATER.
- Review of patient demographics, disease onset, clinical criteria (e.g., 1958 ARA criteria), joint counts, serological markers (e.g., rheumatoid factor, ANA), and treatment data (e.g., DMARDs, biologics).
- Longitudinal assessment of disease activity, progression, functional status, and treatment response over time.
Main Results:
- Early RA can follow self-limited or progressive disease courses, with baseline swollen/tender joint counts predicting progression.
- In one cohort, only 45% met RA criteria at one year, highlighting diagnostic challenges; active joint count was a key determinant of function.
- Treatment data show high utilization of methotrexate (MTX) and varying American College of Rheumatology 20% improvement (ACR20) responses; many early RA patients may not meet criteria for biologic trials.
Conclusions:
- Early rheumatoid arthritis exhibits significant heterogeneity in disease course and response to treatment.
- Predictive factors like joint counts are crucial for identifying patients at risk of progressive disease.
- Ongoing research in early RA cohorts is vital to evaluate the long-term impact of novel therapies and aggressive intervention strategies on patient outcomes.
Abstract:
Several databases of patients with early rheumatoid arthritis (RA) have been established in the USA. The University of Tennessee at Memphis Cohort was organized in 1967-1971 to enroll 50 young adults (16-44 years) with symptom onset of < or = 6 months who met the 1958 American Rheumatism Association (ARA) criteria for at least probable RA. Two important observations from this database were that many patients seen within the first 6 months of meeting the criteria for probable RA have a self-limited rather than progressive disease, and that progressive disease is predicted by a high number of baseline swollen and tender joints. The National Institutes of Health (NIH) cohort of patients with peripheral synovitis for > or = 6 weeks but < 12 months in at least one peripheral joint was established in 1994. At the one-year follow-up, 45% of the patients met the RA criteria, 9% had reactive arthritis, 6% had psoriatic arthritis, 5% had other rheumatic diseases, and 35% had undifferentiated arthritis. The number of active joints, rather than meeting the criteria for RA, was the primary determinant of function and performance after one year. The Western Consortium of Practicing Rheumatologists (CPR) was established in 1993 to enroll patients with an RA duration < 1 year, positive rheumatoid factor, > or = 6 swollen and > or = 9 tender joints, and no previous treatment with disease modifying anti-rheumatic drugs (DMARDs). Data from this cohort indicated the validity of self-report joint counts. American College of Rheumatology 20% improvement (ACR20) responses were seen in 50% of patients at 6 months and in 57% of patients at 24 months, while antinuclear antibodies (ANA) were seen in 69% of patients prior to the availability of biologic agents. The North American Cohort of Patients with Early RA (SONORA), which included patients with symptoms for > 3 but < 12 months, indicated that methotrexate (MTX) was the most frequently prescribed DMARD, being taken by more than half the patients. The Consortium for the Longitudinal Evaluation of African-Americans with RA (CLEAR) registry and DNA repository has enrolled 123 African-American patients with early RA of less than 2 years' duration to analyze genetic and non-genetic factors associated with disease severity. The Early RA Treatment Evaluation Registry (ERATER) of patients with early RA (< 3 years) was established in 2001. In this registry, MTX was the first DMARD used in 83% of patients, and most patients would not meet the criteria for inclusion in recent clinical trials of biological agents. Further observation of recent cohorts of patients with early RA over the next decade should be informative regarding whether aggressive intervention strategies and new DMARDs and biologic agents lead to improved long-term outcomes.
