Reumatologia: pesquisas atuais
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Early Inflammatory Polyarthritis: Case Study

Morelia Nunez-Sotelo, Luis Arturo Gutierrez-Gonzalez, Nancy Gonzalez and Benito Losada

To determine which patients with early inflammatory polyarthritis (EIP) with less than a year of evolution of the disease without a definitive diagnosis, progressed to rheumatoid arthritis according to ACR1987 criteria, we developed a predictive model for classification of early rheumatoid arthritis, based on clinical characteristics by observation of the onset of the disease and to relate with certain laboratory variables. A total of 54 patients with arthritis of less than one year of evolution were evaluated. We conducted a physical examination and the following parameters were determined: DAS 28, HAQ, rheumatoid factor (RF), citrullinated peptide (anti-CCP) and c-telopeptide (CTx-II); radiology of hands and feet was also carried out, and was assessed by the Sharp method modified by van der Heijde. The patient follow-up was performed every3 months for 12 months, classifying them according to the development of self-limiting, persistent non-erosive, and persistent erosive arthritis, and according to definite diagnosis. We estimated the relative risk and 95% confidence intervals for the predictor variables considered. Overall, 80.4% of patients with EIP evolved to persistent arthritis. Most persistent arthritis was diagnosed as rheumatoid arthritis (67.4%). A positive serology in patients with rheumatoid arthritis was 70% for RF, 61.5% for anti-CCP and 61% for CTx-II. The basal nodes and RF were able to predict the persistence of activity and symmetry; rheumatoid nodules predict the development of erosions. An initial erosive disease increases the risk of radiological progression.