Related Experiment Video
Updated: Jun 6, 2026
Measuring Psoriasis Severity at Home
Published on: March 1, 2024
Disease activity, smoking, and reproductive-related predictors of poor prognosis in patients with very early
Suzanne M M Verstappen1, Melanie J McCoy, Chris Roberts
1The University of Manchester, Manchester M13 9PT, UK.
Insights
Rheumatoid factor positivity and current smoking are key predictors of poor prognosis in early inflammatory polyarthritis (IP). Early treatment with disease-modifying antirheumatic drugs (DMARDs) and smoking cessation are recommended for patients with IP.
Area of Science:
- Rheumatology
- Clinical Prediction Modeling
Background:
- Early inflammatory polyarthritis (IP) requires accurate prognostic markers to guide treatment decisions.
- Identifying predictors of poor prognosis in very early IP is crucial for timely intervention.
Purpose of the Study:
- To identify predictors of poor prognosis in patients with very early inflammatory polyarthritis (IP).
- To assess the role of disease activity, smoking, and reproductive factors in predicting disease progression.
Main Methods:
- A cohort of patients with very early IP (symptom duration 4-11 weeks) from the STIVEA trial were analyzed.
- Logistic regression was used to identify baseline predictors of poor prognosis, defined as need for DMARD therapy by 6 months or RA diagnosis by 12 months.
Main Results:
- Rheumatoid factor (RF) positivity strongly predicted a poor prognosis (OR for DMARDs at 6 months: 4.00; OR for RA at 12 months: 9.48).
- Current smoking at baseline was significantly associated with an RA diagnosis at 12 months (OR 3.15).
- Approximately 6 in 7 RF-positive IP patients were diagnosed with RA within 1 year.
Conclusions:
- RF-positive IP patients have a high likelihood of developing RA, with 6 in 7 diagnosed within a year.
- Smoking is a significant risk factor, with 1 in 4 IP patients who smoke developing RA.
- Early treatment with DMARDs for RF-positive IP and smoking cessation advice are recommended.
Objective:
To identify disease activity, smoking, and reproductive-related predictors of a poor prognosis in patients with very early inflammatory polyarthritis (IP).
Methods:
Patients with very early IP (symptom duration 4-11 weeks) included in our study were participants in the STIVEA (Steroids In Very Early Arthritis) randomized placebo-controlled trial. At baseline, disease-related variables were measured and patients were asked to complete a questionnaire covering smoking status and reproductive questions. Baseline predictors of poor prognosis [i.e., the need to start disease-modifying antirheumatic drug (DMARD) therapy by 6 months or the clinical diagnosis of rheumatoid arthritis (RA) at 12 months] were identified, applying logistic regression analyses adjusted for treatment group.
Results:
Rheumatoid factor (RF) positivity was one of the strongest clinical predictors of a poor prognosis: OR for DMARD therapy at 6 months, 4.00 (95% CI 2.00-8.00) and OR for a diagnosis of RA at 12 months, 9.48 (95% CI 4.48-20.07). There was a significant association between current smoking at baseline compared to never smoking and a diagnosis of RA at 12 months (OR 3.15, 95% CI 1.16-8.56).
Conclusion:
About 6 in 7 patients with very early RF-positive IP were diagnosed with RA 1 year later. In addition, 1 in 4 IP patients who smoke will develop RA later. It is recommended to treat RF-positive patients who have IP with DMARD at presentation and to advise patients to stop smoking.
Related Concept Videos
01:25Inflammatory Bowel Disease III: Crohn's Disease
01:24Chronic Obstructive Pulmonary Disease III: Chronic Bronchitis Features