LATE-ONSET RHEUMATOID-ARTHRITIS - IS PITTING EDEMA OF THE HANDS AT ONSET A GOOD PROGNOSTIC INDICATOR

This prospective study compares the clinical and radiological outcome of patients with late-onset (age 65 yr and over) rheumatoid arthritis (RA) presenting with and without pitting oedema of the hands (POH). Tw enty-two patients with POH (Group 1) were compared with 81 (Group 2) w ithout POH (median age of onset of RA-Group 1: 74.3; Group 2: 73.1; fe male to male ratio-Group 1: 1.2: 1; Group 2: 2.5: 1). The median time between the onset of arthritis and baseline assessment was 3 months. M inimum follow-up was 1 yr (median 2.4). Outcome was defined by (1) the development of erosions of the hands, wrists or feet and (2) the numb er of patients in remission (clinically inactive disease on two clinic visits 3 months apart with no intervening history of inflammatory joi nt disease). IgM rheumatoid factor (IgM RF) was less frequent in patie nts with POH (Group 1: 8.2%; Group 2: 43.2%, P less than or equal to 0 .05). Logistic regression analysis showed that POH at onset was indepe ndent of IgM RF in determining outcome. Patients with POH were less li kely to develop erosions [odds ratio (OR) = 0.16, 95% confidence inter val (CI) 0.03, 0.89]. Although initial cross-tabulation suggested an i ncreased frequency of remission in Group 1 (Group 1: 90.9%; Group 2: 5 5.5%, P = 0.02), POH was not found to be a significant predictor using the logistic regression model (OR = 7.42, 95% CI 0.84, 65.7). Patient s with IBM RF were more likely to develop erosions (OR = 5.1, 95% CI 1 .46, 17.67) and less likely to go into remission (OR = 0.19, 95% CI 0. 06, 0.68).