THE RELEVANCE OF PREDICTING RHEUMATHOID ARTHRITIS SEVERITY: FACILITATING EARLY TREATMENT IN POOR PROGNOSIS AND PROGNOSTIC LABORATORY MARKERS OF JOINT DAMAGE

Dejan Spasovski; Emilija Sandevska; Aleksandra Pivkova-Veljanovska; Svetlana Krstevska Balkanov; Slavica Subevska-Stratrova

Dejan Spasovski University Clinic for Rheumatology, Clinical Center â€œMother Theresaâ€, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
Emilija Sandevska University Clinic for Rheumatology, Clinical Center â€œMother Theresaâ€, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
Aleksandra Pivkova-Veljanovska University Clinic for Haematology,Clinical Center â€œMother Theresaâ€, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
Svetlana Krstevska Balkanov University Clinic for Haematology,Clinical Center â€œMother Theresaâ€, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia
Slavica Subevska-Stratrova University Clinic for Endocrinology, 4 Clinical Center â€œMother Theresaâ€, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, R. North Macedonia

Abstract

Simultaneous testing especially of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF), which are reversible measures of inflammation, together with clinical variables of inflammatory synovitis are recommended for evaluation of disease activity. In this study 35 patients (pts) with early RA were included, while 35 pts were in the healthy control group. Pts were treated with Methotrexate at an average dose of 10 mg once weekly. RA was evaluated following the dynamics of changes of the mean values of ESR, CRP and RF. Statistical analysis showed statistically significant differences among mean values of ESR in the four time intervals (p=0.00002). Regarding CRP, there were statistically significant differences among mean values in all four time intervals (p=0.0428) (standard deviations were with great variations). There were no statistically significant differences of RF in the four time intervals (p=0.573). We found high values of CRP and RF in most of the patients. In spite of the therapy with Methotrexate, disease progression continues especially in patients with elevated values of ESR, CRP and RF, which are shown as predictors for aggressive course of disease. This enables selection of high risk groups of patients for aggressive course of disease and points to the need of early and aggressive treatment.

Keywords: rheumatoid arthritis, reactants of the acute phase, rheumatoid factor

https://doi.org/10.55302/JMS2142019s

References

1. Brower AC Imaging In: Klippel JH, Dieppe PA Rheumatoid arthritis and other synovial disorders London WCIH 9
LB UK: Mosby International Lynton House 7-12 Tavistock Square; 1998. Chapter 5 : 5.1.
2. Kuper IH, Van Leeuwen MA, Van Riel PLCM, Sluiter WJ, Houtman NM, Cats HA, Van Rijswijk MH. Influence of a
ceiling effect on the assessment of radiographic progression in rheumatoid arthritis during the first 6 years of
disease. J Rheumatol 1999; 26:268-76.
3. Larsen A, Thoen J. Hand radiography of 200 patients with rheumatoid arthritis repeated after an interval of
one year. Scand J Rheumatology 1987; 16 : 395 -401.
4. Belghomari H, Saraux A, Allain J, Guedes C, Youinou P, Goff PL. Risk factors for radiographic articular
destruction of hands and wrists in rheumatoid arthritis. J Rheumatol 1999; 26: 2534-8.
5. Sharp JT, Lidsky MD, Collins LC, Moreland J. Methods of scoring the progression of radiologic changes in
rheumatoid arthritis. Arthritis Rheum 1971;14 :706-720.
6. Molenaar ETH, Edmonds J, Boers M, van der Heijde DMFN, Lassere M. A practical exercise in reading RA
radiographs by the Larsen and Sharp methods. J Rheumatol 1999; 26: 746-8.
7. Guillemin F, Billot L, Boini S, Gerard N, Odegaard S, Kvien TK. Reproducibility and sensitivity to change of 5
methods for scoring hand radiographic damage in patients with rheumatoid arthritis . J Rheumatol 2005; 32:
778-86.
8. Williams AL, O'Sullivan MM, Lewis PA, Coles EC, Jessop JD. Relationship between time-integrated c-reactive
protein levels and radiologic progression in patients with rheumatoid arthritis. Arthritis Rheum 2000 ; 43 :
1473- 1477.
9. Kirwan JR. The relationship between synovitis and erosions in rheumatoid arthritis. Br J Rheumatol1997 ; 36 : 2
25-228
10. Mottonen T, Paimela L, Leirisalo-Repo M, Kautiainen H, IIonen J, Hannonen P: Only high disease activity and
positive rheumatoid factor indicate poor prognosis in patients with early rheumatoid arthritis treated with
"sawtooth" strategy. Ann Rheum Dis, 1998; 57(9) : 533-9.
11. Mauricie E, Jeurissen MD; Agnes M, Boerbooms T. MD, PhD; Levinus BA, van de Putte, MD, PhD; , Doesburg
WH, NSc; Lemmens AM, MD, . Influence of methotrexate and azathioprine on radiologic progression in
rheumatoid arthritis. Ann Intern Med 1991; 114:999-1004.
12. Weinblatt ME, Trentham DE, Fraser PA. Long-term prospective trial of low-dose methotrexate in reheumatoid
arthritis. Arthritis Rheum 1988;31:167-75.
13. Kremer JM, Phelps CT. Long - term prospective study of the use of methotrexate in the treatment of
rheumatoid arthritis: update after a mean of 90 months. Arthritis Rheum 1992; 35: 138- 45.
14. Reykdal S, Steinsson K, Sigurjonsson K, Brekkan A. Methotrexate treatment of rheumatoid arthritis: effects on
radiological progression . Scand J Rheumatol. 1989 ; 18 : 221-6.
15. Strand V, Sharp JT Radiographic data from recent randomized controlled trials in rheumatoid arthritis.
Arthritis Rheum 2003; 48: 21-34.
16. Van Leuwwen MA, van Rijswijk MH, Sluiter WJ. Individual relationship between progression of radiological
damage and the acute phase response in early rheumatoid arthritis. Towards a decision support system. J
Rheumatol 1997; 24:20-7.
17. Visser H, le Cessie S, Vos K, Breedveld FC, Hazes J. How to diagnose rheumatoid arthritis early: a prediction
model for persistent( erosive) arthritis. Arthitis rheum 2002; 46: 357-65.
18. Redlich K, Hayer S, Ricci R. Osteoclasts are essential for TNF-a-mediated joint destruction. J Clin Invest 2002;
110:1419-27.
19. Joosten LA,Lubberts E, Helsen MM. Protection against cartilage and bone destruction by systemic interleukin
- 4 treatment in established murine type ii collagen - induced arthrits. Arthritis Res 1999; 1 : 81- 91.
20. O' Dell JR. Therapeutic strategies for rheumatoid arthritis. N E J Med 2004; 350 : 2591 -602.
21. Belghomari H, Saraux A, Allain J, Guedes C, Youinou P, Goff PL. Risk factors for radiographic articular
destruction of hands and wrists in rheumatoid arthritis. J Rheumatol 1999; 26: 2534-8.
22. Capell HA, Porter DR, Madhok R, Hunter JA. Second line ( disease modifying) treatment in rheumatoid
arthritis: which drug for which patient? Ann Rheum Dis 1993; 52 :423-8.
23. Hoekstra M,van Ede AE, Haagsma CJ. Factors associated with toxicity, final dose, and efficacy of methotrexate
in patients with rheumatoid arthritis. Ann Rheum Dis 2003; 62: 423-6.
24. Van der Heide A, Remme CA, Hoffman DM, Jacobs JWG, Bijlsma JWJ. Prediction of progression of radiographic
damage in newly diagnosed rheumatoid arthritis. Arthritis Rheum 1995; 38 : 146-75.
25. Jansen LMA, van der Horst - Bruinsma IE, van Schaardenburg D, Bezemer PD, Dijkmans BAC. Predictors of
radiographic join damage in patients with early rheumatoid arthritis. Ann Rheum Dis 2001; 60: 924-027
26. Michael JP, Arnold LW, O'Sullivan MM, Lewis PA, Coles EC, Jessop JD. Relationship between time- integrated c-
reactive protein levels and radiologic progression in patients with rheumatoid arthritis. Arthritis Rheum 2000;
43 : 1473 - 1477.