Disputation: Gina Charlotte Hetland Brinkmann – Rheumatology
Cand.med. Gina Charlotte Hetland Brinkmann at the Institute of Clinical Medicine will be defending the thesis “Disease course, radiographic joint damage and the Treat to Target principle in patients with early arthritis”for the degree of Philosophiae doctor (PhD).
Trial lecture - time and place
See Trial Lecture.
- First opponent: Docent Saedis Saevarsdottir, Karolinska Institutet
- Second opponent: Associate professor Mari Hoff, Norwegian University of Science and Technology
- Third member of the adjudication committee: Associate Professor Frank Becker, University of Oslo
Chair of the Defence
Professor John-Anker Zwart, University of Oslo
Post.doc. Elisabeth Lie, Diakonhjemmet Hospital
Early arthritis may develop into a specific chronic rheumatic disease, e.g. rheumatoid arthritis (RA), resolve or remain undifferentiated arthritis (UA). The ability to identify patients who most likely will progress to RA is important. Early identification will ensure that those who may benefit from early intervention receive appropriate treatment, as well as to prevent overtreatment.
The treatment target of early arthritis should be to reduce disease activity and prevent joint destruction. Consequently, “treat to target” (T2T) has become an attractive concept in the clinical management of RA. T2T is defined as a treatment strategy in which the clinician treats the patient aggressively to reach and maintain a specified treatment goal, such as remission (i.e. no signs and symptoms of active disease) or low disease activity.
The general aim of this thesis was to explore disease characteristics, disease course, radiographic joint damage in early arthritis patients, and treatment strategies in patients with early RA by using three observational studies.
Only 10% of all patients with early UA developed RA during 2 years of follow-up. In addition to female sex, seropositivity and small joint involvement, presentation with a swollen shoulder joint was associated with development of RA.
About 3/4 of all patients with early UA achieved remission without the use of disease-modifying antirheumatic drugs (DMARDs) within 2 years. Only a few patients had joint damage on x-rays, so-called erosions, typical for RA, almost all of them at baseline. Despite having erosions at baseline most of the patients ended up with other clinical diagnoses than RA. The T2T strategy leads to higher rates of remission than traditional routine care in early RA.
In conclusion, < 1 in 6 patients with UA needed DMARD for their arthritis to resolve over 2 years, and implementation of T2T follow-up in patients with early RA in clinical practice is both feasible and beneficial.
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