Diagnosis and prognosis of rheumatoid arthritis: focus on diagnostic methods.

Objectives Rheumatoid arthritis (RA) leads to destructive changes and dysfunction of joints. Ultrasound (US) changes, especially in early RA, are considered as one of the ways of assessing the course of the disease and predicting its outcomes.Objective(s): to identify the features of the course of RA using imaging methods. Materials 85 RA pts, mean age 53,0 [44,0; 61,0] yrs, mean disease duration 8 [4; 24] months were treated by Treat-To-Target concept. After first year of therapy management was following real clinical practice rules until the termination of the study (4 years FUP). The wrist, MCP2 and MCP3, PIP2, PIP3, MTP2 and MTP5 joints of the clinically dominant side were examined by US (gray scale (GS) and power Doppler (PD). Clinical, laboratory parameters and US examination was performed at baseline, at Mo 3, 6, 9 and 12. The X-ray was conducted before treatment, at 12 Mo and in the end of the study. Structural damage progression was evaluated by change in the Sharp van der Heijde score (ΔSHS) between baseline and 4 year.We categorized pts into 2 groups according to duration of the course of the disease: 1) early RA (the duration of the disease is less than 12 months), 2) non-early RA (more than 12 months). Results 56 early RA pts (66%) and 29 non-early RA pts (34%) patients presented among the 85 patients with RA.RA progression by 4 years the follow-up period was identified in 17 pts (30%) of early RA group and in 16 pts (55%) of non-early RA group.RA progression by 4 years the follow-up period was identified in 39% of pts.In non-early RA group the count of erosion at baseline, at 12Mo and 4 years was significantly higher than in early RA group (1 [0; 5] and 0 [0; 2], 2 [0; 6] and 0 [0; 3], 3 [2; 10] and 1 [0; 4], respectively, p=0.03, p=0.03 and p=0.001 respectively).Also in non-early RA group the GS at 6 and 12Mo was significantly higher than in early RA group (5 [3; 8] and 3 [2; 7], 5 [3; 8] and 3 [1; 5], respectively, p=0.02 and p=0.02 respectively). Conclusions This study shows the importance of timely therapy in the development of destructive changes in RA.