Clinically suspect arthralgia: the course towards rheumatoid arthritis and spontaneous resolution

Abstract

Rheumatoid arthritis (RA) is often preceded by a phase in which clinically apparent joint inflammation is not yet present, but the rheumatologist considers the joint symptoms suspicious for development of RA. This phase is referred to as clinically suspect arthralgia (CSA). This thesis investigated why some patients with CSA develop RA while others recover spontaneously. In addition, symptoms and illness perceptions of patients with CSA and early RA were studied. Large patient cohorts were followed for several years to study patterns, predictive factors, and underlying mechanisms in the transition from CSA to RA. Factors associated with the development of RA included symptoms particularly affecting the hands, lower socioeconomic status, patient-reported joint swelling, and indications of previous severe periodontitis. At the same time, a considerable proportion of individuals with CSA did not develop RA and recovered spontaneously, in some cases despite the presence of autoantibodies and MRI-detected inflammation. This suggests that, in addition to risk factors, protective mechanisms may also play a role. Symptoms and illness perceptions of patients with CSA worsened prior to the development of RA.

These findings highlight the importance of early detection and further research into both risk factors and mechanisms of recovery, with explicit attention to the patient perspective.