THU0127 Development of Draft Criteria for Arthralgia that is Clinically Suspect for Progression to Rheumatoid Arthritis; Results of Phase 1

Abstract

BackgroundThe development of RA consists of different phases, including the phase of arthralgia without clinically apparent arthritis. This phase is not well defined in terms of symptom-content, hampering the appropriate delineation of patients eligible for trials. Clinical expertise is a valuable tool to delineate arthralgia patients at risk for RA. Variation in clinical expertise and practice exist. To employ clinical experience in a consensus-based approach, a EULAR task force consisting of 18 rheumatologists, 2 patients, 3 health professionals from different European countries and a research fellow are developing criteria for Clinically Suspect Arthralgia (CSA) with the clinical expertise as external standard.MethodsThe development consists of three phases. In phase 1, a list of clinical items considered as characteristic of CSA will be determined. In phase 2, 40 existing patients presented on paper with information on the items established in phase 1 will be classified by the participants. Candidate criteria will be based on the items discriminating between CSA and non-CSA. In phase 3 (validation) the criteria will be tested in patients referred to the participating centers. The expert opinion will be the reference in all phases; the final criteria will be established by voting. This abstract reports on the results of phase 1. Experts were asked to state all symptoms and signs relevant for considering an arthralgia patient as suspected for progression to RA. Then these items were evaluated in a modified Delphi approach.ResultsThe experts made a list of 55 symptoms and signs that were considered relevant. Then in 3 rounds (modified Delphi) the items that were considered most relevant to identify CSA were selected. Based on consensus, 16 items were obtained. These were: symptoms of recent onset (duration <1 year), symptoms located in MCPs, symptoms located in MTPs, symptoms located in several small joint regions, symmetric symptoms, 4-10 joints with symptoms, morning stiffness ≥60 minutes, most severe symptoms in early morning, improvement of symptoms during the day, increasing number of joints with symptoms over time, patient-experience of swollen small hand joints, difficulty with making a fist, presence of a first degree relative with RA, local tenderness involved joints at physical examination, positive squeeze-test of MCPs, positive squeeze-test of MTPs. These items will be evaluated in phase 2.ConclusionsAn ongoing EULAR task force has identified consensus-based criteria for arthralgia being clinically suspect for progression to RA that will be subjected to further validation.Disclosure of InterestNone declared

Absence of ultrasound inflammation in patients presenting with arthralgia rules out the development of arthritis

“…We missed those patients who might be at risk for IA but had only one painful (large) joint. However, our inclusion criteria are in line with other arthralgia cohorts and with the new EULAR guidelines regarding clinically suspect arthralgia [ 22 , 24 ]. Other forms of selection may have occurred due to rheumatologists who recruited clinically suspected patients with possibly more severe symptoms [ 25 ].…”