What predicts rapid disease progression in patients with early rheumatoid arthritis?

This study investigated the factors that may predict disease progression in patients with early rheumatoid arthritis. They found that history of smoking and elevated inflammation may predict rapid radiological progression.

Rheumatoid arthritis is a condition that causes painful swelling and inflammation in the joints. Patient care is focused on reducing these symptoms to prevent the tissue in these joints from degenerating or dying. 

Some patients can face a rapid disease progression, meaning their symptoms get progressively worse much quicker than others. Identifying patients at risk of this rapid radiographic progression (RRP) is important to prevent tissue damage.

Some factors such as body mass index (BMI) and lifestyle habits may increase the risk of RPP. However, there is conflicting evidence on what factors are most relevant. Identifying factors that may predispose a person to RRP could be used to predict which patients are at higher risk.

This study investigated the factors that may relate to RRP in patients with early RA.

This study included 233 patients with early RA. Patients were assessed at the beginning of the study, and 1 and 5 years later. At the beginning, patient characteristics, such as body mass index (a measure of body fat that takes height and weight into account), smoking status and details of the disease state and treatment were noted.  

The presence of certain proteins that are involved in inflammation were significant predictors of RRP (rheumatoid factor (RF), c-reactive protein (CRP), etc.). Smoking was also linked to an increased risk of RRP. Patients who were overweight or obese had a reduced risk of RRP over 5 years. Patients who had higher disease activity at 1 year were more likely to have RRP at 5 years.

The authors concluded that history of smoking and elevated inflammation may predict rapid radiological progression.

The number of patients included in this study was relatively small. Larger studies are needed to confirm these results. 71% of these patients were women, so the results may not extend to all male patients.

If you have any questions relating to treatment or lifestyle factors in rheumatoid arthritis, please discuss these with your physician.