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This paper is the second in a series of two reviews which and so we have used them in this paper. Thus RA is a subset of IP. focus on the work of the Norfolk Arthritis Register (NOAR), a register of primary care-based inception Previous prospective studies investigating predictors of cohort patients with inflammatory polyarthritis (IP). outcome in early IP The first paper examined genetic and environmental risk factors for the development of IP and of its subset, Table 1 lists all prospective studies which have included at least 50 patients with early (disease duration <3 yr) rheumatoid arthritis (RA) [91]. This paper summarizes the outcome of those patients recruited in 1990–1993 IP and which have investigated clinical and/or genetic predictors of outcome. Most are from European centres, and followed for 3 yr in terms of remission of synovitis, the development of physical disability and radiological probably because differences in the delivery of health care make it difficult to perform such studies in North erosions. We have also examined prognostic indicators. Most of these results have not been published previously America. Over 75% of these reports used the ACR criteria for RA to select patients for study. and this is the first time we have looked at all three outcomes in the same group of patients. The NOAR An accurate picture of disease outcome in IP is best obtained by recruiting patients soon after symptom data are presented in the context of a detailed review of previous studies of IP and RA. onset and following them prospectively [68]. The studies listed in Table 1 were all based in hospital clinics, although some tried to recruit patients more widely Background from the local population [29, 33] or by invitation to attend early arthritis clinics [50, 54]. Compared with The ability to predict disease outcome in patients newly presenting with inflammatory polyarthritis (IP) would community-based studies, hospital-based studies are easier to establish and maintain, and offer greater diabe useful from a variety of perspectives [1], not least that of the patient. For example, there is mounting gnostic certainty. However, left censorship is a major problem in hospital-based studies, particularly those evidence that, to achieve their maximum potential, disease-modifying anti-rheumatic drugs (DMARDs) that recruit using classification criteria for RA, because they exclude patients with mild disease and who enter should be given as soon as possible after disease onset, before the disease process has become established and remission early. The Norfolk Arthritis Register (NOAR) aims to recruit all patients with a new onset of IP who irreversible damage has occurred [2–9]. In order to target treatment appropriately and to avoid exposing present to primary care [69]. Details of the referral and assessment procedures were presented in the previous patients with mild disease to potentially toxic drugs, it would be helpful to know which patients with IP are paper in this series [91]. In this paper we examine disease outcome and prelikely to go on to develop severe rheumatoid arthritis (RA). dictors of prognosis among patients newly presenting with IP/RA, with emphasis on data from patients Many studies are confined to patients who satisfy the 1987 American College of Rheumatology (ACR) classireferred to NOAR. fication criteria for RA [10]. These criteria do not NOAR study population used in this review perform well in identifying patients with early IP who will later develop RA [11]. Nevertheless, they do give Between January 1990 and February 1993, 635 patients were referred to NOAR. Of these, 56 were later excluded some consistency in patient selection between studies because of an alternative diagnosis. Of the remaining 579 patients, 486 (84%) were followed for 3 yr, 24 (4%) Submitted 18 August 1999; revised version accepted 3 March 2000. died, 41 (7%) declined further participation and 28 (5%) Correspondence to: D. Symmons, ARC Epidemiology Unit, Oxford Road, Manchester M13 9PT, UK. were lost to follow-up. The baseline characteristics of

Early inflammatory polyarthritis: results from the Norfolk Arthritis Register with a review of the literature. II. Outcome at three years