Læknablaðið : fylgirit - 01.05.1978, Blaðsíða 31

Heinola Study Group, 18120 Heinola 12, Finland RHEUMATOID FACTOR AND
THE PROGRESSION OF
INF LAMMATORY ARTHRITIS
The purpose of this study was to evaluate the
importance of different clinical and laboratory
parameters in predicting the prognosis of the
joint disease at its early stage. The progress
of the disease was measured by funetional
disability and joint swelling scores after one
follow-up.
The patient material included 279 arthritis
patients. The studied parameters were measured
not more than six months from the appearing of
the first symptoms. The parameters used are
shown in table 1.
The material was devided into three groups
according to the progress of the disease during
one year. Both functional disability and joint
swelling groups were used (table 2 and 3).
In comparisons between these groups differences
of means were used.
R esults:
Differences between functional disability groups
showed that age had the greatest differentiating
power (table 4). The prognostic value of clinical
measurements (morning stiffness, joint tender-
ness, joint swelling) was also highly significant,
while of the laboratory parameters only ESR and
Waaler-Rose had significant differentiating power.
Table 5 shows that when material was divided
into three groups according to joint swelling the
differentiating power of parameters increased.
The clinical status scores again had the best
prognostic value, age had lost but ESB and
rheumatoid factor, especiaUy Latex, had
increased their significance.
Antinuclear antibodies and complement factors
had the least importance in this context.
When the statistical analysis (table 6) was
computed separately with RA-patients, the group
with the worst prognosis differed significantly
from milder cases (groups 1 and 2). The best
predictors now were Latex-titre and number of
swoUen joints.
When the functional disabUity groups were used
in multiple discriminant analysis, age increased
most the discriminating power. After that came
joint tenderness, C4, morning stiffness and
Latex.
Discussion:
The predicting of the prognosis of inflammatory
joint disease at the early stage is very important
for the planning of rehabUitation and care of the
patient. Low complement level and high rheuma-
toid fact titre have been considered sign of poor
prognosis in RA. This material however consists
of different arthritis cases, and earlier results
cannot be compared with the results of this study.
The measuring of the prognosis of the disease
can be done by functional disabUity, joint involve-
ment, radiological changes, activity of the
inflammation and deteriorating in social status
and changes in psychological reactions. In this
study only functional disability and joint swelling
were used as a criterion for prognosis. Of
these the functional disabUity had a highly signifi-
cant correlation with the age (p < 0.001) and
therefore makes the results invalid in this respect.
Correlation between the age and the joint swelling
was not significant and therefore joint sweUing is
a better sign for the prognosis.
In conclusion it can be said that clinical para-
meters, especially the duration of morning stiff-
ness and the number of swollen joints predict
best the prognosis of the joint disease after one
year. Of the laboratoiy tests, ESR and rheuma-
toid factor have the greatest predicting value.
Table 1 Age
•pOTD
VARIABLES
S-muco
S-CRP
S-IgG
S-IgA
S-Waaler-Rose
S-Latex-titre
S-Latex
S-Antinuclear antibodies
S-C 3
S-C 4
S-E 1 -inhibitor
Morning stiffness
Joint tenderness
Joint swelling
Punctional disability
29
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