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Published on: February 22, 2019
Outcome of early monoarthritis: a followup study
Aymeric Binard1, Seydou Alassane, Valérie Devauchelle-Pensec
1Unit of Rheumatology and the Laboratory of Immunology, la Cavale Blanche Hospital, Brest Teaching Hospitals, Brest, France.
Objective:
To evaluate clinical, laboratory, and radiological features and outcomes in patients with monoarthritis (MA), identified in a cohort of patients with early arthritis.
Methods:
A cohort of 270 patients with undiagnosed arthritis of less than 1 year's duration was divided into 3 groups: single episode of MA (MA, n = 27), MA with a history of patient-reported arthritis (MA + past, n = 23), and oligo- or polyarthritis (OA/PA, n = 220). At 6-month intervals, all patients underwent a standardized examination, radiographs, and standard laboratory tests including rheumatoid factors (RF), antiperinuclear factor (APF), antikeratin antibody (AKA), anticyclic citrullinated peptide antibody (anti-CCP), antinuclear antibodies, and HLA-AB-DR typing. After a median followup of 30 months, the diagnosis was evaluated by a hospital-based rheumatologist.
Results:
Age and sex did not differ across the 3 groups. Knee involvement was more common in the MA group than in the MA + past group (p < 0.03), whereas hand and metatarsophalangeal involvement was less common (p < 0.03 and p < 0.0001, respectively). RF and anti-CCP were less often positive in the MA group than in the MA + past group (p < 0.02 and p < 0.001, respectively) and the OA/PA group (p < 0.02 and p < 0.03). No patient in the MA group received a diagnosis of rheumatoid arthritis (RA). RA was less common and disease modifying antirheumatic drugs were prescribed less often in the MA group than in the other 2 groups (p < 0.0001 for both comparisons).
Conclusion:
The MA group was clearly different from the other groups, with a favorable outcome and no risk of progression to RA.
Insights
Patients with a single episode of monoarthritis (MA) showed a favorable outcome and no progression to rheumatoid arthritis (RA). Early arthritis evaluation revealed distinct clinical and laboratory features for MA patients compared to other groups.
Area of Science:
- Rheumatology
- Clinical Immunology
- Arthritis Research
Background:
- Early arthritis diagnosis is crucial for effective management.
- Monoarthritis (MA) in early arthritis cohorts requires detailed characterization.
- Distinguishing MA from oligo- or polyarthritis (OA/PA) is important for prognosis.
Purpose of the Study:
- To evaluate clinical, laboratory, and radiological features of monoarthritis (MA) in early arthritis patients.
- To assess the outcomes and risk of progression to rheumatoid arthritis (RA) in MA patients.
- To compare MA patients with those experiencing oligo- or polyarthritis (OA/PA) or a history of arthritis.
Main Methods:
- A cohort of 270 early arthritis patients was categorized into single episode MA, MA with past arthritis, and OA/PA groups.
- Standardized examinations, radiographs, and laboratory tests (including rheumatoid factors, anti-CCP) were performed at 6-month intervals.
- Median follow-up was 30 months, with final diagnosis by a rheumatologist.
Main Results:
- The MA group showed less hand and metatarsophalangeal involvement but more knee involvement compared to the MA + past group.
- Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) were less frequently positive in the MA group.
- No MA patient developed rheumatoid arthritis (RA), and RA was less common in this group compared to others.
Conclusions:
- Monoarthritis (MA) in early arthritis is distinct from other presentations.
- Patients with a single episode of MA have a favorable prognosis.
- There is no observed risk of progression to rheumatoid arthritis (RA) in the MA group.
