Martina Hansens Hospital, Sandvika, Norway, Diakonhjemmet Hospital, and University of Oslo, Oslo, Norway.
Østfold Hospital Trust, Grålum, Norway, and Diakonhjemmet Hospital, Oslo, Norway.
Arthritis Care Res (Hoboken). 2020 May;72(5):705-710. doi: 10.1002/acr.23334. Epub 2020 Apr 8.
The present study was undertaken to investigate the joint distribution and 2-year outcome of patients with recent-onset monoarthritis.
Adult patients with clinically apparent monoarthritis of ≤16 weeks' duration were included in a multicenter 2-year longitudinal study. Clinical characteristics, joint distribution, development of chronic inflammatory rheumatic disease (CIRD), as well as classification criteria according to the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 criteria for RA were studied. Predictors for development of CIRD were analyzed by multivariable logistic regression analyses.
The knee (49.3%), ankle (16.7%), and wrist (14.1%) were the most frequently affected joints among the 347 included patients. A total of 91 patients (26.2%) developed CIRD during follow-up; 21 (6.1%) were diagnosed with RA, and 16 (4.6%) with psoriatic arthritis. Longer duration of joint swelling, joint localization, and anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) positivity were independent predictors of CIRD. Six of 58 patients (10.3%) with ankle monoarthritis and 21 of 49 patients (42.9%) with wrist monoarthritis developed CIRD during follow-up. The 2010 ACR/EULAR Criteria for RA identified all patients diagnosed with seropositive RA at an early stage, mostly within 3 months.
Approximately one-fourth of patients with recent-onset monoarthritis developed CIRD over 2 years. Patients presenting with ankle arthritis rarely developed CIRD, whereas patients presenting with wrist arthritis more frequently did so. Longer duration of joint swelling and ACPA and RF positivity were also predictive of CIRD. Our findings facilitate the early identification of patients with monoarthritis who have an unfavorable prognosis.
本研究旨在探讨新发单关节炎患者的联合分布和 2 年转归。
本研究纳入了一项多中心、2 年纵向研究中患有临床明显的单关节炎且病程≤16 周的成年患者。研究了临床特征、关节分布、慢性炎症性风湿病（CIRD）的发展，以及根据美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）2010 年 RA 分类标准进行分类的标准。采用多变量逻辑回归分析来分析 CIRD 发生的预测因素。
在 347 例纳入的患者中，最常受累的关节分别是膝关节（49.3%）、踝关节（16.7%）和腕关节（14.1%）。在随访期间，共有 91 例（26.2%）患者发生 CIRD；21 例（6.1%）被诊断为 RA，16 例（4.6%）为银屑病关节炎。关节肿胀持续时间较长、关节定位、抗瓜氨酸蛋白抗体（ACPA）和类风湿因子（RF）阳性是 CIRD 的独立预测因素。58 例踝关节单关节炎患者中有 6 例（10.3%），49 例腕关节单关节炎患者中有 21 例（42.9%）在随访期间发生了 CIRD。2010 年 ACR/EULAR RA 标准在早期（大多在 3 个月内）识别出所有血清阳性 RA 患者。
大约四分之一的新发单关节炎患者在 2 年内发生 CIRD。踝关节关节炎患者很少发生 CIRD，而腕关节炎患者更常见。关节肿胀持续时间较长、ACPA 和 RF 阳性也是 CIRD 的预测因素。我们的发现有助于早期识别预后不良的单关节炎患者。
