Polyarticular arthritis,independent of rheumatoid factor,is associated with poor functional outcome in recent onset inflammatory synovitis

Abstract

The biological, physical and functional status change was measured in 104 patients with recent ( $\mathrm{<}1$ year) onset synovitis. Measurements were taken initially and at 1 year. The purpose was to determine which biological and physical measures correlated with poor performance. Patients completed questionnaires quantifying activity, (the Human Activity Profile [HAP] and Sickness Impact Profile [SIP]), pain (Wisconsin Brief Pain Inventory), fatigue (Multidimensional Assessment of Fatigue), sleep, and mood (POMS and CES-D). They were evaluated for articular involvement (Ritchie Index) and biological markers of disease activity (platelets, sedimentation rate, C-reactive protein and rheumatoid factor) (RF). In all, 30 men and 74 women participated. A total of 45 patients met the American College of Rheumatology criteria for rheumatoid arthritis (RA); of these, 24 were rheumatoid factor (RF) positive, 18 had spondylitis, and 41 had unclassified arthritis. Low activity level at 1 year (HAP and SIP) correlated with high numbers of inflamed joints initially ( $\mathit{p}\mathrm{<}0.002$ ); with more than 10 involved joints regardless of diagnostic group $\mathit{p}=0.001$ ); and joint symmetry ( $\mathit{p}\mathrm{<}0.009$ ) A high platelet count was associated with low activity level at 1 year ( $\mathit{p}=0.01$ ); and high sedimentation rate was associated with more pain ( $\mathit{p}\mathrm{<}0.05$ ). Low activity level ( $\mathit{p}\mathrm{<}0.04$ ), fatigue ( $\mathit{p}=0.03$ ) and sleeplessness ( $\mathit{p}=0.02$ ) were correlated with RF+ RA.