Publications by authors named "Hanna W van Steenbergen"
Background: Conventional radiographs of hands and feet are used to depict structural damage in rheumatoid arthritis (RA). This is also commonly done in clinical practice in symptomatic patients at risk for RA (clinically suspect arthralgia (CSA)), but its rationale is unclear. We aimed to investigate the prevalence of radiographic erosive disease in patients with CSA and its progression over time.
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- The study examined whether the belief that all individuals with rheumatoid arthritis (RA) go through a 'pre-RA' phase of symptoms (arthralgia) is true by analyzing new RA patients over a decade.
- It included a cohort of 699 individuals diagnosed with RA, comparing those who had warning symptoms before diagnosis against those who did not, using advanced statistical methods.
- Findings revealed only about 55% of the patients experienced this 'pre-RA' stage, and those who did were generally younger and more likely to have specific antibodies, but they struggled more with long-term remission compared to those who did not have previous symptoms.
Article Synopsis
- * ACPA-negative patients generally have more swollen joints, but the prevalence of swollen metatarsophalangeal (MTP) joints and walking disabilities is similar across both groups, while ACPA-positive patients show greater prevalence of inflamed tissues.
- * Different types of inflammation are associated with specific symptoms: in ACPA-positive patients, intermetatarsal bursitis relates to MTP joint issues, while in ACPA-negative patients, synovitis is more
Article Synopsis
- Scientists noticed a new type of inflammation in the hand tendons of people with rheumatoid arthritis and those at risk, which might happen before arthritis symptoms show up.
- They ran an MRI study on adults with joint pain and healthy people to see how often this tendon inflammation occurs and how it relates to other joint problems.
- The study included 667 patients and helped researchers understand if tendon inflammation could be an early sign of rheumatoid arthritis.
Article Synopsis
- Obesity is a known risk factor for rheumatoid arthritis (RA), but its influence during either the asymptomatic phase or the symptomatic clinically suspect arthralgia (CSA) phase is unclear.
- A study of 1,107 symptomatic patients showed that those with CSA were more likely to be obese compared to the general population, with obesity rates significantly higher across different cohorts.
- However, obesity did not show a significant association with the progression to inflammatory arthritis among CSA patients, suggesting that the risk from obesity may occur earlier in the RA development process.
The concept of a 'window of opportunity' in treating a disease assumes the existence of a time frame during which the trajectory of the disease can be effectively and permanently modified. In rheumatoid arthritis (RA), optimal timing of this period is presumed to be during the phase before arthritis is clinically apparent and disease is diagnosed. Several proof-of-concept trials of treatment during the 'arthralgia' phase of RA have been completed in the past 4 years, with the underlying notion that temporary treatment at this stage could prevent the development of RA or induce a sustained reduction in the burden of disease.
View Article and Find Full Text PDFObjective: Obesity conveys a risk for RA development, while paradoxically, associating with less radiographic progression after RA diagnosis. Using MRI we can study this surprising association in detail from MRI-detected synovitis and osteitis to MRI-detected erosive progression, which precedes radiographic progression. Previous research suggested obesity associates with less osteitis and synovitis.
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- - The study aimed to understand how joint inflammation progresses in patients with clinically suspect arthralgia (CSA) who later develop rheumatoid arthritis (RA) and how it changes when CSA resolves spontaneously.
- - Researchers analyzed MRIs from 185 CSA patients, tracking levels of inflammation in joint tissues over time to see if changes happened simultaneously or in a particular sequence.
- - Findings revealed that in patients who progressed to RA, inflammation in different tissues increased together, with osteitis rising sharply right before RA diagnosis, while in those whose pain resolved, inflammation levels decreased in a sequential manner.
The value of inquiring about functional impairments for early identification of inflammatory arthritis: a large cross-sectional derivation and validation study from the Netherlands.
BMJ Open
December 2020
Objectives: Healthcare professionals other than rheumatologists experience difficulties in detecting early inflammatory arthritis (IA) by joint examination. Self-reported symptoms are increasingly considered as helpful and could be incorporated in online tools to assist healthcare professionals, but first their discriminative ability must be assessed. As part of this effort, we evaluated whether inquiring about functional impairments could aid early IA identification.
View Article and Find Full Text PDFIntroduction: Arthralgia and MRI-detected subclinical inflammation can precede the development of clinically evident rheumatoid arthritis (RA). However, part of the patients presenting with clinically suspect arthralgia (CSA) do not progress to RA. In these 'non-progressors', we aimed to study the frequencies of spontaneous improvement of arthralgia and its relation with the course of subclinical inflammation.
View Article and Find Full Text PDFObjectives: National and international guidelines recommend prompt referral of patients presenting with inflammatory arthritis (IA), but general practitioners (GPs) feel uncertain in their proficiency to detect synovitis through joint examination, the method of choice to identify IA. Our objective was to develop and validate a rule composed of clinical characteristics to assist GPs and other physicians in identifying IA when in doubt.
Design: Split-sample derivation and validation study.
Article Synopsis
- * Among 350 joints studied, 71 showed subclinical inflammation at the start, with varying outcomes where some resolved, some remained inflamed, and others progressed to clinical synovitis.
- * The findings suggest that the transition from subclinical inflammation to IA is more of a systemic process rather than limited to specific local areas in the joint.
Article Synopsis
- * In a cohort of 1352 UA patients, 33% progressed to RA under the old criteria (1987), while only 6% progressed under the newer criteria (2010); anti-CarP antibodies were linked to a higher chance of developing RA, especially in those negative for ACPA and RF.
- * Although anti-CarP showed promise in predicting RA in the 1987-setting, its predictive validity diminished when accounting for
Article Synopsis
- MRI is recommended for early diagnosis of rheumatoid arthritis (RA) to detect joint damage, but symptom-free individuals, especially the elderly, can also show similar erosions.
- A study compared MRI results of 589 early arthritis patients (238 with RA) and 193 symptom-free controls, focusing on erosion scores and inflammation in the joints.
- Results indicated that while RA patients had significantly higher erosion scores, the specific erosion characteristics were infrequently present, suggesting the need for caution in distinguishing RA from other conditions based solely on MRI findings.
Moderate use of alcohol is associated with lower levels of C reactive protein but not with less severe joint inflammation: a cross-sectional study in early RA and healthy volunteers.
RMD Open
January 2018
Article Synopsis
- Moderate alcohol consumption is linked to lower levels of systemic inflammation and may protect against rheumatoid arthritis (RA), but its effect on joint inflammation severity is unclear.
- A study involving 188 RA patients and 192 asymptomatic volunteers assessed joint inflammation via MRI while considering their alcohol intake.
- Results showed no significant relationship between alcohol consumption and joint inflammation severity, but a J-shaped curve indicated that moderate drinking (1-7 drinks/week) was associated with lower C reactive protein levels, suggesting a systemic rather than local effect of alcohol.
Article Synopsis
- Early treatment of rheumatoid arthritis (RA) can lead to better outcomes, highlighting a "window of opportunity" where interventions may be most effective.
- Autoantibodies and inflammation markers can show up before clinical arthritis, indicating that targeting the pre-arthritis phase could potentially prevent the full development of the disease.
- Ongoing trials are examining prevention strategies, emphasizing the need for accurate risk assessment and understanding patient perspectives to improve clinical practices.
Article Synopsis
- - The study aimed to evaluate the predictive value of autoantibodies (ACPA, RF, and anti-CarP) for developing clinical arthritis in patients with suspected rheumatic arthritis, specifically among those with clinically suspect arthralgia (CSA).
- - Out of 241 patients followed for about 2 years, ACPA was found to be the most significant predictor of arthritis progression, with a hazard ratio of 5.1, while RF and anti-CarP also showed associations but were less predictive.
- - Despite higher levels of ACPA and RF correlating with increased arthritis risk, over 30% of patients who tested ACPA-positive and RF-positive did not develop arthritis within the follow-up period, indicating that not all
Article Synopsis
- A EULAR-taskforce developed a definition for arthralgia that indicates a higher likelihood of evolving into rheumatoid arthritis (RA), aimed at creating consistent patient groups for clinical studies.
- This study validated the definition in 241 patients identified as having clinically suspect arthralgia (CSA) and assessed its performance in another group of 113 referred patients.
- Results indicated that the definition is effective when used by rheumatologists, but much less so without their evaluation, suggesting that clinical assessment should be paired with biomarkers for better diagnostic accuracy.
Article Synopsis
- * Results showed that using MRI data from symptom-free volunteers improved the specificity of inflammation detection in CSA and UA patients, reducing false positives significantly.
- * The increase in specificity and accuracy came without affecting sensitivity, highlighting a novel approach in MRI's role for early RA detection that aligns with common practices in other medical tests.
Article Synopsis
- A study assessed functional disability in patients with clinically suspect arthralgia (CSA) to understand its correlation with subclinical inflammation as detected by MRI, as well as how it progresses to rheumatoid arthritis (RA).
- Out of 241 patients studied over nearly three years, it was found that higher MRI inflammation scores linked to more significant functional limitations, indicating that patients with CSA might already face serious difficulties.
- The results suggest that HAQ scores of 1.0 or higher at the onset of CSA could predict later development of clinical arthritis, highlighting the importance of monitoring functional ability even before RA is diagnosed.
Article Synopsis
- The study examined differences in symptoms between ACPA-positive and ACPA-negative rheumatoid arthritis (RA) patients during the pre-RA phase, revealing distinct clinical presentations despite similar initial diagnoses.
- ACPA-negative patients showed less lower extremity involvement and developed arthritis more slowly than ACPA-positive patients, who experienced longer symptom durations and fewer tender joints at presentation.
- The findings suggest that ACPA-positive and ACPA-negative RA may have different underlying mechanisms and clinical progressions, highlighting the need for tailored approaches to their management.
Article Synopsis
- The study evaluated the diagnostic potential of MRI for identifying early rheumatoid arthritis (RA) in patients who initially present with unclassified arthritis (UA), where a clear diagnosis is not immediate.
- It involved 589 early arthritis patients, comparing MRI results against those of symptom-free controls, and following UA patients over a year to see who developed RA or began disease-modifying therapies.
- MRI findings, particularly detecting tenosynovitis, were significant indicators for RA progression, showing high negative predictive value and moderate positive predictive value, especially effective in patients presenting with oligoarthritis.
Background: During the transition to rheumatoid arthritis (RA) many patients pass through a phase characterised by the presence of symptoms without clinically apparent synovitis. These symptoms are not well-characterised. This taskforce aimed to define the clinical characteristics of patients with arthralgia who are considered at risk for RA by experts based on their clinical experience.
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- High BMI is generally linked to increased inflammation but shows an opposite trend in rheumatoid arthritis (RA), suggesting a unique relationship.
- In a study of 195 RA patients and others, higher BMI correlated with increased inflammation in non-RA conditions but decreased inflammation in RA, measured via MRI scans.
- The findings indicate that higher BMI leads to milder synovitis and bone marrow edema in RA, potentially clarifying the unexpected association between obesity and less disease progression in these patients.