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Issues in rheumatoid arthritis

1999; Elsevier BV; Volume: 353; Issue: 9159 Linguagem: Inglês

10.1016/s0140-6736(05)74406-8

1474-547X

Andrei Călin,

Herpesvirus Infections and Treatments

Dennis McGonagle and colleagues (Jan 9, p 123)1McGonagle D Gibbon W O'Connor P et al.An anatomical explanation for goodprognosis rheumatoid arthritis.Lancet. 1999; 353: 123-124Summary Full Text Full Text PDF PubMed Scopus (41) Google Scholar conclude that magnetic resonance imaging studies early on in the course of rheumatoid arthritis (RA) can provide data suggesting good or bad prognosis. However, we are told very little about the patients with so-called rheumatoid arthritis. Their patients were divided into those with “acute onset RA” on the one hand, and insidious onset disease on the other. The criteria used for inclusion were those of the American College of Rheumatology. However, it is well recognised that patients with viral arthropathy, spondylarthropathy, and various selflimiting arthritides can fulfil these criteria.2Calin A Marks S The case against seronegative rheumatoid arthritis.Am J Med. 1981; 70: 992-994Summary Full Text PDF PubMed Scopus (43) Google Scholar, 3Burns T Calin A The hand radiograph as a diagnostic discriminant between seropositive and seronegative “rheumatoid arthritis”: a controlled study.Ann Rheum Dis. 1983; 42: 605-612Crossref PubMed Scopus (48) Google Scholar Only long-term observation determines whether these individuals do indeed have chronic seropositive erosive rheumatoid disease. One useful prognosticator is that of the rheumatoid factor status.4Calin A Elswood J Klouda P Destructive arthritis, rheumatoid factor HLA DR4: susceptibility versus severity: a case-control study.Arthritis Rheum. 1989; 32: 1221-1225Crossref PubMed Scopus (78) Google Scholar Is expensive magnetic resonance imaging scanning a better prognosticator than a simple test for rheumatoid factor? Clearly, if most of those individuals who had a good outlook were seronegative, one would have to question whether they merely had a self-limiting nonrheumatoid, post-viral, or other benign condition. I wonder what proportion of their 22 patients with bad outcome were seropositive at the time of assessment, compared with the eight patients with good outcome.