University of Oulu

Weman L, Salo H, Kuusalo L, Huhtakangas J, Kärki J, Vähäsalo P, et al. (2023) Initial presentation of early rheumatoid arthritis. PLoS ONE 18(7): e0287707.

Initial presentation of early rheumatoid arthritis

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Author: Weman, Lauri1; Salo, Henri2; Kuusalo, Laura3;
Organizations: 1University of Eastern Finland and Jyväskylä Central Hospital, Jyväskylä, Finland
2Finnish Institute for Health and Welfare (THL), Data and Analytics, Helsinki, Finland
3Department of Internal Medicine, University of Turku and Turku University Hospital, Turku, Finland
4Division of Rheumatology, Kuopio University Hospital, Kuopio, Finland
5Department of Children and Adolescents, Kanta-Häme Central Hospital, Hämeenlinna, Finland
6Department of Children and Adolescents, Research Unit of Clinical Medicine, University of Oulu, Oulu University Hospital and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
7Department of Paediatrics, Wellbeing Services County of Ostrobothnia, Vaasa, Finland
8Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Public Library of Science, 2023
Publish Date: 2023-08-16


Objectives: To study the joint distribution and clinical picture of rheumatoid arthritis (RA) at the initial presentation in seropositive (anti-citrullinated protein antibody (ACPA) and/or rheumatoid factor (RF) positive) and negative patients and the effect of duration of symptoms on the clinical picture.

Methods: Data of patients who received reimbursement for DMARDs for newly diagnosed RA in 1/2019 to 9/2021 were extracted from the national databases. Joint counts, presence of symmetrical swelling, other disease activity measures, and patient reported outcomes (PROs) were compared in seropositive and negative patients. Regression analyses were applied to compare clinical variables in patients with duration of symptoms of <3, 3–6, and >6 months, adjusted for age, sex, and seropositivity.

Results: Data of 1816 ACPA and RF-tested patients were included. Symmetrical swelling was present in 75% of patients. Seronegative versus positive patients had higher value for all disease activity measures and PROs including median swollen joint count (SJC46 10 versus 5) and DAS28 (4.7 versus 3.7), (p<0.001). Patients diagnosed in <3 months had higher median pain VAS (62 versus 52 and 50, p<0.001) and HAQ (1.1 versus 0.9 and 0.75, p = 0.002) compared to those with a duration of symptoms of 3–6 and >6 months. Patients diagnosed >6 months were ACPA-positive more frequently (77% versus 70% in other groups, p = 0.045).

Conclusion: Incident RA presents mainly as symmetric arthritis. Seronegative patients have higher disease burden at the initial presentation. Patients experiencing more severe pain and decreased functional ability are diagnosed earlier, regardless of ACPA- status.

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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 18
Issue: 7
Article number: e0287707
DOI: 10.1371/journal.pone.0287707
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: We would like to thank The Finnish Psoriasis Association, The Finnish Society for Rheumatology, and Amgen. The author also acknowledges the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project 5041730, Kuopio, Finland). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2023 Weman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.