Document Detail


Prognostic factors for the development of rheumatoid arthritis and other connective tissue diseases in patients with palindromic rheumatism.
MedLine Citation:
PMID:  10090159     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Palindromic rheumatism is characterized by attacks of acute arthritis of short duration. In the long term, a substantial proportion of patients will develop rheumatoid arthritis (RA) or other connective tissue diseases, but the determinants of subsequent chronic disease have not been adequately established. We identify clinical prognostic factors for the development of RA and other connective tissue diseases in patients with palindromic rheumatism in a retrospective cohort study. METHODS: The medical records of 4900 patients with arthritis referred from 1986 to 1996 to 3 rheumatologists at an academic center were reviewed. One hundred sixty patients were diagnosed as having palindromic rheumatism. After review, 127 complied with diagnostic criteria for palindromic rheumatism. Disease duration was estimated as time of first attack until the last consultation, or the development of RA or other connective tissue disease. Survival analysis including Cox regression was used to identify clinical variables associated with the risk of developing RA or other connective tissue disease, adjusting for varying disease duration. RESULTS: Sixty-five percent of the patients were female. Age at onset was 40+/-12 years. Mean disease duration was 6+/-6 years, and mean followup by the rheumatologists was 40+/-45 months. Joints more frequently affected were wrist, knee, and metacarpophalangeal. Forty-three patients (34%) subsequently developed a connective tissue disease including 36 (28%) RA, 3 (2%) systemic lupus erythematosus, and 4 (3%) other connective tissue diseases. In the final Cox regression model the hazard ratio for development of a connective tissue disease in the presence of a positive rheumatoid factor (RF) was 2.9 (p = 0.002), for proximal interphalangeal (PIP) joint involvement 2.4 (p = 0.02), for wrist involvement 2.5 (p = 0.05), for female sex 2.2 (p = 0.05), and for age at onset 1.03 (per year) (p = 0.001). Female patients with positive RF and involvement of the hands had an 8-fold risk of developing disease, compared with patients with one or fewer of these features. CONCLUSION: Positive RF and early involvement of the wrist and PIP joints predict the subsequent development of RA or other connective tissue disease in patients with palindromic rheumatism, and identify a group of patients at increased risk.
Authors:
L Gonzalez-Lopez; J I Gamez-Nava; G S Jhangri; C Ramos-Remus; A S Russell; M E Suarez-Almazor
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of rheumatology     Volume:  26     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  1999 Mar 
Date Detail:
Created Date:  1999-05-07     Completed Date:  1999-05-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  540-5     Citation Subset:  IM    
Affiliation:
Healthcare Quality and Outcomes Research Centre, Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age of Onset
Arthritis, Rheumatoid / diagnosis*,  etiology,  mortality
Cohort Studies
Connective Tissue Diseases / diagnosis*,  etiology,  mortality
Female
Humans
Joints / pathology
Male
Prognosis
Proportional Hazards Models
Retrospective Studies
Rheumatic Diseases / complications
Rheumatoid Factor / analysis
Survival Rate
Chemical
Reg. No./Substance:
9009-79-4/Rheumatoid Factor

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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