292
Views
30
CrossRef citations to date
0
Altmetric
Articles

The presence of rheumatoid nodules at early rheumatoid arthritis diagnosis is a sign of extra-articular disease and predicts radiographic progression of joint destruction over 5 years

, , , , , , , & show all
Pages 81-87 | Accepted 15 Jul 2010, Published online: 05 Oct 2010
 

Abstract

Objective: Radiographic damage is an important outcome in rheumatoid arthritis (RA). The disease course varies considerably, and there is a need for simple and reliable prognostic markers. The aim of the study was to determine the utility of early signs of extra-articular disease, manifested as rheumatoid nodules (RN), in predicting radiographic outcome.

Methods: In a cohort (n = 1589) of consecutive, newly diagnosed patients with RA, 112 cases with RN at inclusion (7%) were identified. Each case was compared to two age- and sex-matched controls without nodules from the same cohort. Radiographs of the hands and feet were performed at inclusion, after 1, 2, and 5 years and scored according to the modified Sharp van der Heijde Score (SHS; range 0–448).

Results: Fifty-two cases with RN and 139 controls without RN had available radiographs at baseline and after 5 years. Cases were more often rheumatoid factor (RF) positive and anti-cyclic citrullinated peptide (anti-CCP) positive, and had higher disease activity and radiographic damage scores at baseline (7.9 vs. 2.5). After 5 years, there was more extensive radiographic damage among the cases (mean SHS progression 21.7 vs. 13.5). In bivariate analysis, positive RF, positive anti-CCP, SHS, and RN were strong baseline predictors for radiographic progression up to 5 years. In multivariate analysis, positive anti-CCP and SHS at baseline were independently associated with radiographic progression.

Conclusion: The presence of RN at baseline is a marker of extra-articular involvement and severe disease, and a predictor of subsequent joint damage.

Acknowledgements

We thank the BARFOT study group, M Ahlmén, J Bratt, K Forslind, I Hafström, C Keller, I Leden, B Lindell, B Svensson, A Teleman, and J Theander, for their support and for contributing patients to the study, and all colleagues at the Spenshult Hospital for Rheumatic Diseases, Karolinska University Hospital Huddinge, and the general hospitals in Helsingborg, Kalmar, Kristianstad, and Mölndal, for their help with patient recruitment. This study was supported by grants from the Centre for Clinical Research Dalarna, Falun, Sweden, the Department of Rheumatology, Falun Hospital, Falun, Sweden, the Swedish Rheumatism Association, the Swedish Society of Medicine, and the Crafoord Foundation, Sweden.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.