medwireNews: Localized inflammatory factors may play a role in joint swelling among people with rheumatoid arthritis (RA), say researchers who found that swelling tends to recur in the same joints over time.
Sascha Heckert (Leiden University Medical Center, the Netherlands) and team analyzed data for 508 people (average age 54 years) with newly diagnosed RA (median symptom duration 23 weeks) who were participating in the multicenter BeSt study.
The study compared four different treat-to-target strategies (sequential monotherapy; step-up combination therapy starting with methotrexate; initial combination therapy with methotrexate, sulfasalazine, and prednisone; and initial combination therapy with methotrexate and infliximab), assessing swelling in 68 joints every 3 months for a median of 10 years.
At baseline, participants had a mean DAS of 4.42 points and 24% of the 34,423 joints assessed were swollen (mean 16 per patient).
During follow-up, recurrent swelling – that is, swelling in a joint that was not swollen at the previous visit – occurred in 46% of the joints that were swollen at baseline. By comparison, swelling occurred at least once in 19% of joints that were not swollen at baseline.
The researchers report in the Annals of the Rheumatic Diseases that there was a significant 2.37-fold higher odds for swelling in a particular joint during follow-up if that joint was swollen at baseline, compared with no baseline swelling.
And further analysis revealed that local joint swelling during follow-up was significantly better predicted by baseline swelling at that specific joint than by randomly selected other joints.
“This joint-specific association may suggest that apart from systemic effects of systemic inflammatory processes in RA, local conditions in individual joints affect the course of inflammation in these joints,” Heckert and co-authors remark.
The investigators also found that baseline swelling was significantly associated with both recurrent and persistent swelling, at odds ratios of 1.73 for joints that were not swollen at a previous visit and 1.52 for those that were.
Heckert et al say their findings “might support more intensive local monitoring, including imaging techniques if joints appear clinically no longer swollen,” particularly because “[s]ubclinical inflammation has been found to be associated with radiographic progression.”
However, they conclude that further work “is needed to investigate the consequences of recurrence of joint swelling, and potentially find the mechanisms behind it,” which may in turn “lead to advances in personalised monitoring and treatment of patients with RA.”
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