Late-onset rheumatoid arthritis: is pitting oedema of the hands at onset a good prognostic indicator?

This prospective study compares the clinical and radiological outcome ofpatients with late-onset (age 65 yr and over) rheumatoid arthritis (RA)presenting with and without pitting oedema of the hands (POH). Twenty-twopatients with POH (Group 1) were compared with 81 (Group 2) without POH(median age of onset of RA-Group 1: 74.3; Group 2: 73.1; female to male.ratio-Group 1: 1.2:1; Group 2: 2.5:1). The median time between the onset ofarthritis and baseline assessment was 3 months. Minimum follow-up was 1 yr(median 2.4). Outcome was defined by (1) the development of erosions of thehands, wrists or feet and (2) the number of patients in remission(clinically inactive disease on two clinic visits 3 months apart with nointervening history of inflammatory joint disease). IgM rheumatoid factor(IgM RF) was less frequent in patients with POH (Group 1:8.2%; Group 2:43.2%, P < or = 0.05). Logistic regression analysis showed that POH atonset was independent of IgM RF in determining outcome. Patients with POHwere less likely to develop erosions [odds ratio (OR) = 0.16, 95%confidence interval (CI) 0.03, 0.89]. Although initial cross-tabulationsuggested an increased frequency of remission in Group 1 (Group 1: 90.9%;Group 2: 55.5%, P = 0.02), POH was not found to be a significant predictorusing the logistic regression model (OR = 7.42, 95% CI 0.84, 65.7).Patients with IgM RF were more likely to develop erosions (OR = 5.1, 95% CI1.46, 17.67) and less likely to go into remission (OR = 0.19, 95% CI 0.06,0.68).