the predictive value of ultrasound in early rheumatoid arthritis

Conditions: Rheumatoid Arthritis; Predictive Value of Ultrasound in Early Rheumatoid Arthritis

Summary: rheumatoid arthritis a chronic and progressive inflammatory disease characterized by synovial membrane inflammation, possibly leading to destruction of joints. to start early with a combination therapy results in a better outcome for patients. using ultrasonography it is possible to detect clinically and radiographically absent synovitis and erosions. however, it is unclear whether or not these findings have predictive value in these patients regarding disease activity or radiographical progression.

patients will be evaluated using the standard diagnostic workup of patients with early arthritis. this includes history taking, physical examination, disease activity score of 44 joints (das44) and a laboratory test, including c-reactive protein(crp), erythrocyte sedimentation rate (esr), complete blood count (cbc), rheumatoid factor (rf), anti-cyclic citrullinated peptide(anti-ccp), transaminases, urinanalysis. also part of the standard workup for these patients are x-rays of hands and feet to detect erosions. the baseline medication will include - in concordance with european league against rheumatism (eular)-guidelines and the provisional 'nederlandse vereniging voor reumatologie(nvr)'-guidelines - methotrexate (mtx) for all patients. the medicine regimes are part of the ongoing cohort studies from which the patients will be recruited. evaluating the medicine effects is not part of the 'echografie bij vroege artritis (eva)(ultrasound in early arthritis)' study. all consecutive rheumatoid arthritis (ra) patients will be asked to participate in this study. they will receive oral and written information about the eva study. approximately two weeks after this first consultation the patient returns to his or her rheumatologist for the diagnosis and accompanying treatment. if the patient decides to participate in this study they fill out the informed consent form. the patient will be asked to fill out the health assessment questionnaire (haq) and the short form-36 (sf-36). after this, at baseline, at three months and at 12 months, metatarsophalangeal (mtp) 2-5(dorsal aspect) and metacarpophalangeal (mcp) 2-5(dorsal, palmar, lateral) and wrists of each patient will be examined with ultrasound by a single rheumatologist per centre specialized in ultrasound (us). this rheumatologist will be unaware of the clinical, laboratory and radiographic findings.

Eligibility criteria:
inclusion criteria: * newly diagnosed rheumatoid arthritis patients, diagnosed according to the american college of rheumatology (acr) 1987-criteria * naïve for disease modifying anti rheumatic drugs (dmards), biologicals and glucocorticoids. * starting with treatment with a potent anti-rheumaticum. e.g. methotrexate (mtx), biologicals or glucocorticoids. exclusion criteria: * contra-indications for mtx, biologicals or glucocorticoids. * insufficient ability to read and write in dutch * personality disorders that limit the participation in the study

Keywords: early rheumatoid arthritis rheumatoid arthritis ultrasound predictive prognosis