Introduction: Early undifferentiated arthritis has varied outcome: majority remits spontaneously and about 1/3rd evolve into rheumatoid arthritis (RA). Objective: To find out the clinical feature of early arthritis, its outcome, predictors of its evolution into rheumatoid arthritis and of its spontaneous remission and the outcome of treatment of early rheumatoid arthritis. Method: Fifty-three patients (37 females) were recruited. Logistic-regression analysis was done to find out inde- pendent predictors of early arthritis evolving into RA or remitting spontaneously and the Receiving Operating Characteristic curve analysis was done to examine the validity of the Prediction rule. Result: About half of the patients had spontaneous remission and rest evolved into RA. The majority (31.4%) of patients with early arthritis presented with symmetric arthritis involving both upper and lower limbs. A low DAS28 (odds ratio 0.384, P = 0.002) at presentation was the predictor of evolution into RA whereas anti-CCP antibody neg- ativity (odds ratio 0.222, P = 0.044) was predictor of spontaneous resolution. Conclusion: The anti-CCP antibody predicted disease remission whereas low disease activity predicted disease persistence. Larger sample size with longer duration of follow-up is needed.

Objective: To measure serum and synovial COMP levels in rheumatoid arthritis (RA) and osteoarthritis (OA) patients and to assess their correlation with clinical, laboratory and ultrasonographic parameters. Methods: Two groups of patients were included in this study consisting of 32 patients with RA and 10 patients with knee OA. Ultrasonography of knee joints was performed and serum and synovial Cartilage oligomeric matrix protein (COMP) levels were measured using an inhibition ELISA. Results: The mean synovial COMP level was significantly higher in RA compared to OA patients (14.3 ± 5.19 μg/mL and 9.26 ± 2.42 μg/mL respectively, P < 0.01). Amongst RA patients, it was higher in those with erosions. COMP lev- els were higher in synovial fluid compared to serum levels in both groups (P < 0.01). Amongst RA patients, synovial COMP levels showed a significant positive correlation with synovial membrane thickness on ultrasonography (P < 0.001), and significant negative correlation with the cartilage thickness (P < 0.001). In OA group, synovial and serum COMP level showed significant positive correlation with WOMAC index for the lower limbs (r = 0.64, P < 0.05, and r = 0.92, P < 0.001 respectively) and a significant negative correlation with cartilage thickness (P < 0.001). Conclusion: The synovial COMP and ultrasonographic joint evaluation may be considered as markers of disease activity and cartilage destruction in both RA and OA patients.

Introduction: Amongst patients with Early arthritis (EA) only some progress to Rheumatoid arthritis (RA) while the majority continue to remain undifferentiated or undergo spontaneous remission. Viral illness may be responsible for some of the self limiting forms of EA. This study was undertaken to evaluate the aetiology and course of EA from India. Objectives: To evaluate the aetiology of EA and identify factors that predicts disease progression to RA at 6 months. Methods: Patients with arthritis of 6 weeks to 6 months duration involving > 2 joints were included with age matched healthy controls. The evaluation included plain radiograph of hands, radionuclide bone scan, ESR, CRP, viral markers (Toxoplasma, Rubella, Cytomegalovirus, Herpes simplex, parvovirus, Dengue, Chikungunya, HIV, Hepatitis B & C) and auto antibodies (Anti CCP, RF and ANA). Patients received weekly injectable steroids for 4 weeks with NSAIDs and were followed up for 6 months. Factors that predicted the development to RA were identified. Results: Of the 30 patients assessed, majority went into spontaneous remission (23/30) with six developing RA and one developing spondyloarthropathy at 6 months. A viral aetiology could not be ascribed to development of arthritis. The presence of higher swollen Joint Count, higher CRP, RF and anti CCP antibodies, erosions on plain radiograph and a positive bone scan predicted progression to RA. Conclusions: Most of EA (almost 80%) is self limiting. Anti CCP antibodies are highly specific for RA and might aid in predicting development of RA.