Role of DMARD Naïve Period in the Development of Severe Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a symmetric poly-arthritis predominantly affecting the small synovial joints, although any synovial joint can be involved. The underlying cause is not known; however, predilection for the disease is impacted by genetic and environmental factors. Several factors predict disease severity in RA including development of erosions, female sex and duration of disease. This study evaluates the role of disease duration, early initiation of disease modifying anti-rheumatic drugs (DMARDs) and auto-antibodies like rheumatoid factor in predicting erosive disease in Indian patients with rheumatoid arthritis.

A 2-year hospital-based cross-sectional observational study was conducted in the Department of Medicine in a tertiary care centre in Kumaon region of Uttarakhand in northern India. 260 patients diagnosed with RA on the basis of 2010 ACR/EULAR criteria were included.

A total of 135 patients had erosive disease, with DMARD naive median period of 3 years compared to 125 patients with non-erosive disease, with DMARD naive median period of 2 years. On the basis of this data and after evaluation for radiographic erosions, it was found that a longer DMARD naive period predicts higher odds of developing erosive disease.

Early diagnosis of rheumatoid arthritis and initiation of DMARDs is crucial in increasing quality of life and preventing severe disease with deformities, erosive changes and extra-articular manifestations.