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Senior Citizen Health & Medicine
Risk of Joint Pain Developing into Rheumatoid
Arthritis Can Be Predicted
Nine variables help determine need for
early aggressive treatment
 January 30, 2007 Pain in the joints and stiffness
are common problems for senior citizens and most often the doctor says
it is "undifferentiated arthritis" (UA), or arthritic symptoms that do
not add up to a specific arthritic disease. The fear is that UA will
progress to RA - rheumatoid arthritis, a potentially disabling disease.
Researches in The Netherlands say they have developed a way to determine
which patients are most likely to go from UA to RA.
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Marked by chronic inflammation of the joints and
tissue, rheumatoid arthritis (RA) is a painful and potentially disabling
autoimmune disease. A wealth of research supports early aggressive
treatment with disease-modifying antirheumatic drugs (DMARDs) as the
best course for preventing joint damage and avoiding the fate of a
wheelchair. But, the use of DMARDs, even the widely prescribed and
generally safe methotrexate, brings the risk of liver damage and other
serious complications.
In 40 to 50 percent of UA sufferers the problem
just goes away, but about one-third develop RA. Physicians often face
the tough choice of whether to initiate DMARD therapy immediately or to
wait and see.
To guide individual treatment decisions,
researchers with the Early Arthritis Clinic at Leiden University Medical
Center, The Netherlands, have found a formula to help determine whether
patients diagnosed with UA are likely to progress to RA. The February
2007 issue of Arthritis & Rheumatism features their simple, reliable
prediction rule for disease outcome.
Starting with clinical data for over 1,700
arthritis patients, the Leiden team identified 570 patients with
recent-onset UA and monitored their disease for one year. At the
culmination of follow-up, 177 of the original UA patients fulfilled the
diagnostic criteria for RA and 150 had achieved remission; the remaining
94 had been diagnosed with another rheumatologic disease.
Through a combination of questionnaires, physical
examination, and blood samples, the team identified 9 clinical variables
with independent predictive value for RA: sex, age, localization of
symptoms, morning stiffness, the tender joint count, the swollen joint
count, the C-reactive protein level, rheumatoid factor positivity, and
the presence of anti-cyclic citrullinated peptide antibodies. Then,
using the area under the curve (AUC), the diagnostic performance of the
prediction rule was evaluated.
A prediction score, ranging from 0 to 14, was
calculated for every patient in the group, with a higher score
indicating a greater risk of developing RA. None of the patients who had
a prediction score of less than 3 progressed to RA during the year-long
observation. In contrast, all of the patients who had a prediction score
of 11 or greater did experience progression to RA. Among the patients
with scores between 4 and 10 who experienced progression to RA, the
frequency of such progression increased with rising scores.
The percentage of patients in whom RA developed was
also assessed according to several cutoff values of the prediction
score. For example, when the scores 5.0 and 9.0 were chosen as cutoff
values, 97 percent of patients with UA who had a score equal to or less
than 5.0 did not develop RA, and a score of equal to or greater than 9.0
was associated with progression to RA in 84 percent of the patients.
"Because the prediction rule is accurate and can be
easily determined in daily clinical practice, the present model is an
important step forward in achieving individualized treatment in patients
with recent-onset UA," notes team spokesperson Dr. Tom W. J. Huizinga.
"Although the validation cohort is relatively small
and the current prediction rule should be evaluated in other
early-arthritis cohorts, we believe that the current model allows
physicians and patients to make an evidence-based choice regarding
whether or not to initiate DMARDs, in the majority of patients
presenting with UA."
Editor's Notes
>>
Link to Arthritis & Rheumatism
Article: "A Prediction Rule for Disease Outcome
in Patients With Recent-Onset Undifferentiated Arthritis: How to Guide
Individual Treatment Decisions," Annette H.M. van der Helm-van Mil,
Saskia le Cessie, Henrike van Dongen, Ferdinand C. Breedveld, Renι E. M.
Toes, and Tom W. J. Huizinga, Arthritis & Rheumatism, February 2007; (DOI:
10.1002/art.22380)
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