Early rheumatoid arthritis: Clinical aspects of new classification criteria and modern treatment strategies
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- Institutt for klinisk medisin [10711]
Abstract
In this thesis Lena Bugge Nordberg assessed clinical aspects of new classification criteria and modern treatment for rheumatoid arthritis (RA). The thesis is based on data from the ARCTIC trial, in which 230 early RA patients were followed for 2 years. Nordberg examined whether the use of ultrasound, in addition to clinical examination, better identifies joints that will benefit from intra-articular glucocorticoid injections. The efficacy of injections was best if ultrasound showed active inflammation in the joint at the time of the injection. The findings support ultrasound as a tool for selection of joints for injection therapy. Nordberg also compared seropositive and seronegative patients fulfilling the new classification criteria for RA. At baseline, seronegative patients had markedly higher levels of joint inflammation than seropositive. After two years of treatment, disease outcomes were similar between groups. The findings suggest that patients now classified as seronegative RA have a more serious disease than before, and require intensive therapy. The results have also contributed to a discussion of the performance of the new classification criteria in seronegative patients.List of papers
Paper I: L. B. Nordberg, S. Lillegraven, A. B. Aga, J. Sexton, E. Lie, H.B. Hammer, I. C. Olsen, T. Uhlig, D. van der Heijde, T. K. Kvien, E. A. Haavardsholm. The impact of ultrasound on the use and efficacy of intra-articular glucocorticoid injections in early rheumatoid arthritis: Secondary analyses from a randomized trial examining the benefit of ultrasound in a clinical tight control regimen. Arthritis Rheumatol 2018;70(8):1192-9. DOI: 10.1002/art.40494. The article is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1002/art.40494 |
Paper II: L. B. Nordberg, S. Lillegraven, E. Lie, A. B. Aga, I. C. Olsen, H. B. Hammer, T. Uhlig, M. K. Jonsson, D. van der Heijde, T. K. Kvien, E. A. Haavardsholm and the ARCTIC working group. Patients with seronegative RA have more inflammatory activity compared with patients with seropositive RA in an inception cohort of DMARD-naïve patients classified according to the 2010 ACR/EULAR criteria. Annals of the Rheumatic Diseases 2017;76(2):341-5. DOI:10.1136/annrheumdis-2015-208873. The article is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1136/annrheumdis-2015-208873 |
Paper III: L. B. Nordberg, S. Lillegraven, A. B. Aga, J. Sexton, I. C. Olsen, E. Lie, H. B. Hammer, T. Uhlig, D. van der Heijde, T. K. Kvien, E. A. Haavardsholm. Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial. RMD Open 2018;4(2):e000752. DOI: 10.1136/rmdopen-2018-000752. The article is included in the thesis. Also available at https://doi.org/10.1136/rmdopen-2018-000752 |