How to diagnose rheumatoid arthritis early: A prediction model for persistent (erosive) arthritis

Abstract

Objective. To develop a clinical model for the prediction, at the first visit, of 3 forms of arthritis outcome: self-limiting, persistent nonerosive, and persistent erosive arthritis.Methods. A standardized diagnostic evaluation was performed on 524 consecutive, newly referred patients with early arthritis. Potentially diagnostic determinants obtained at the first visit from the patient's history, physical examination, and blood and imaging testing were entered in a logistic regression analysis. Arthritis outcome was recorded at 2 years' followup. The discriminative ability of the model was expressed as a receiver operating characteristic (ROC) area under the curve (AUC).Results

Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis: A prospective cohort study

“…In an earlier study with ϳ40% of the same patients as those in the present study, Visser et al developed a prediction model for early arthritis in which outcome of arthritis was used. In that study, anti-CCP antibodies were a predictor of both erosive and persistent arthritis (20). However, studies on the efficacy of interventions that improve functional outcome and retard joint damage are nearly always performed in patients fulfilling the ACR criteria for RA (21)(22)(23).…”

Marked differences in fine specificity and isotype usage of the anti–citrullinated protein antibody in health and disease

“…Among the different autoantibodies described in patients with RA, anti-citrullinated protein antibodies (ACPAs) display the strongest specificity for RA (95-98%), with 70-80% sensitivity (9). The presence of ACPAs in patients with recent-onset RA is predictive for progression to erosive RA (10,11), and their presence in patients with undifferentiated arthritis is highly predictive of progression to RA (12). Likewise, ACPAs were shown to contribute to disease progression in a mouse model of arthritis (13).…”

The case against haste in the treatment of rheumatoid arthritis: Comment on the editorial by Pincus et al

“…Since RA remains a disease of very variable course and, as stated by Visser et al (6), "since treatment with disease-modifying antirheumatic drugs (DMARDs) is only justified when the risk:benefit or costeffectiveness ratios are favorable," it is valuable to review the various observations regarding the accuracy of early diagnosis of RA as well as our ability to predict which patients' disease will follow a progressive erosive course, and to consider whether our current medications will show effectiveness and safety in the community setting as well as in the controlled environment of the clinical trial.…”

“…The initial diagnosis of early inflammatory arthritis led to 60% with self-limiting arthritis, 16% with persistent nonerosive arthritis, and 24% with persistent erosive arthritis at the 2-year followup visit. Of those classified as having RA (30% of the total), 10% had self-limiting disease, 22% had persistent nonerosive disease, and 68% had persistent erosive disease (calculated from Table 2 of Visser et al [6]). According to Visser et al, "patients who had no signs of arthritis at followup but who were taking DMARDs were classified as having persistent arthritis."…”

“…Visser et al (6) provide diagnostic criteria that allow distinction of persistent nonerosive disease from persistent erosive disease. Such distinctions would justify allowing sufficient time to decide whether to use some of the current, potentially toxic therapies.…”