PREDICTORS OF THE LONG-TERM OUTCOME OF EARLY SYNOVITIS: A 5-YEAR FOLLOW-UP STUDY

One hundred patients who presented to an Early Synovitis Clinicin 1979–81 were called for review after a minimum of 5years. Sufficient data for analysis were obtained in 88 cases,of whom 36 had a final diagnosis of rheumatoid arthritis (19seropositive, 17 seronegative) and 16 human parvovirus B19 arthropathy.Outcome was assessed by persistence of symptoms greater than24 months and functional disability by Health Assessment Questionnaire.Sixty-two patients had persistent disease, with 26 showing somefunctional impairment (positive HAQ FDI). A number of presentingfeatures were assessed for their ability to predict outcomeat 5 years. Polyarticular onset of disease was associated witha poor prognosis but lacked both specificity and sensitivity.Certain laboratory tests at presentation, including positiverheumatoid factor and low serum sulphydryl levels, also indicateda poor outcome. Combining these serological abnormalities gave100% specificity for detecting persistent, disabling diseasebut with rather low sensitivity. Thus, other test systems arerequired to increase further the successful prediction of clinicaloutcome in patients with early synovitis. KEY WORDS: Prognosis, Rheumatoid factor, Serum sulphydryl, Laboratory tests, Rheumatoid arthritis