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Published on: May 16, 2025
264
Initial presentation of early rheumatoid arthritis
Lauri Weman1, Henri Salo2, Laura Kuusalo3
1University of Eastern Finland and Jyväskylä Central Hospital, Jyväskylä, Finland.
Plos One
|July 6, 2023
Summary
Seronegative rheumatoid arthritis (RA) patients show higher disease burden initially. Early diagnosis, regardless of ACPA status, is linked to severe pain and functional decline in RA patients.
Area of Science:
- Rheumatology
- Immunology
- Clinical Medicine
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation.
- Serological markers like anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) are crucial for RA diagnosis and classification.
- Understanding initial disease presentation in relation to serostatus and symptom duration is vital for timely management.
Purpose of the Study:
- To investigate the clinical presentation of RA in seropositive versus seronegative patients at initial diagnosis.
- To assess the impact of symptom duration on disease activity and patient-reported outcomes in newly diagnosed RA.
- To compare disease burden between ACPA-positive and ACPA-negative RA patients.
Main Methods:
- Retrospective analysis of national registry data for 1816 newly diagnosed RA patients treated with DMARDs (1/2019-9/2021).
- Comparison of joint counts, symmetrical swelling, disease activity scores (DAS28), and patient-reported outcomes (PROs) based on serostatus (ACPA/RF positive vs. negative).
- Regression analysis to evaluate clinical variables against symptom duration (<3, 3-6, >6 months), adjusted for age, sex, and seropositivity.
Main Results:
- Seronegative RA patients exhibited significantly higher disease activity measures and PROs, including swollen joint count (SJC46: 10 vs. 5) and DAS28 (4.7 vs. 3.7), compared to seropositive patients (p<0.001).
- Patients diagnosed within 3 months reported higher pain (VAS: 62 vs. 52/50) and functional disability (HAQ: 1.1 vs. 0.9/0.75) (p<0.001, p=0.002).
- ACPA positivity was more frequent in patients diagnosed after >6 months of symptoms (77% vs. 70%, p=0.045).
Conclusions:
- Initial RA presentation predominantly involves symmetrical arthritis.
- Seronegative RA patients carry a higher disease burden at diagnosis.
- Earlier RA diagnosis is associated with greater symptom severity (pain, functional impairment), irrespective of ACPA status.
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