Objectives:

The aim of our study is to perform the clinical, functional and ultrasonographic (US) follow-up of the early and very early RA patient who are naive among the disease modifying antirheumatic drugs (DMARDs) for 18 months and evaluate the relationship of these parameters with the radiological final state.

Material and Methods:

This prospective study included 48 early RA (15 very early RA) patients. Gray scale US (GSUS), Power Doppler US (PDUS) examinations, Disease Activity Score 28 (DAS 28), Health Assessment Questionnaire (HAQ), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) were evaluated repeatedly at each visit (baseline, 1, 3, 6, 9, 12, 18 months). Hand, wrist, elbow, shoulder, knee joints and hand, wrist tendon structures were evaluated via GSUS and PDUS.

Results:

During the follow-up period of the patients, the ESR and CRP levels started to decrease statistically significantly from the 1st month (p=0.006). Statistically significant improvement in HAQ, DAS 28 scores, total GSUS synovitis scores, total PDUS tenosynovitis scores, total GSUS tenosynovitis scores, total PDUS tenosynovitis scores started at 3^th months (p=0.007, p=0.003, p=0.001, p=0.009, p=0.002, p=0.004 respectively). In follow-up of very early RA patients; laboratory, US findings were similar to early RA patients. In multiple linear regression analysis, only the GSUS and PDUS scores at 0 and 1, could have an effect on the radiographic progression scores (ß=0.417, p=0011, ß=0.549, p=0.028, ß=0.476, p=0015; ß=0.358, p=0.017, respectively).

Conclusions:

Radiographic damage progresses at the similar severity in early and very early RA patients. The most important factor affecting the radiographic damage progression is the severity of US synovitis at the baseline and in the 1st month, independently of the disease activity.

Keywords: Inflammation, rheumatoid arthritis, synovitis, ultrasonography