Determinants of outcome in early arthritis

Sahbudin, Ilfita (2020). Determinants of outcome in early arthritis. University of Birmingham. Ph.D.

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Abstract

Ultrasound is useful in providing information on subclinical joint and tendon inflammation that is not clinically evident. Current ultrasound technology has very high sensitivity in detecting subtle ultrasound pathology even in healthy joints. In order to use ultrasound effectively it is therefore important to understand the extent of ultrasound findings in healthy individuals, particularly in age ranges where rheumatological disease presents. I have developed a large collaborative network of units experienced in musculoskeletal ultrasound in order to investigate the extent of these ultrasound changes (i.e. synovial hypertrophy, Power Doppler, effusion, osteophytes and erosion) in a large cohort of healthy individuals. Healthy individuals exhibit ultrasound changes in the small joints of the hands, wrists and feet. There is an age-dependent effect of these changes. Synovial effusion is common across all age groups.

Ultrasound has also been established as a predictive tool to identify early arthritis patients who will progress to persistent clinical synovitis. The predictive potential of joint synovitis as measured by ultrasound is well documented. The predictive potential of tendon inflammation measured by ultrasound is not clear. I have investigated the utility of tendon ultrasound variables in the prediction of rheumatoid and persistent arthritis development. Finger flexor tendon showed very promising capacity to predict both rheumatoid arthritis (RA) and persistent arthritis in patients who present within 12 weeks of symptom onset. This is even after taking into account conventional predictors such as RA-related autoantibodies and ultrasound joint synovitis. Finger flexor tendons should thus be considered as a candidate variable when designing prediction algorithms for early arthritis patients.

The ability to predict those who will develop rheumatoid arthritis could allow clinicians to better identify those who require immunosuppressant therapy within the therapeutic window of opportunity. However, the duration of this therapeutic window of opportunity has never been prospectively investigated, particularly in the context of how mode of onset may affect treatment response. Mode of onset refers to how rapid the joint symptoms develop at initial presentation. In this thesis, I classified mode of onset as abrupt, acute or palindromic. I have studied the relationship between treatment response and symptom duration prior to starting DMARDs treatment, taking into account the mode of onset. It appears the mode of onset has a measurable impact on treatment response in RA patients. This novel finding should be further assessed in a larger cohort.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):