| Among those who seek out a rheumatologist's | | | | The percentage of patients in whom RA developed |
| assistance for joint symptoms, one of the most | | | | was also assessed according to several cutoff values |
| common diagnoses is undifferentiated arthritis (UA). | | | | of the prediction score. For example, when the scores |
| This means a specific diagnosis is not yet possible. | | | | 5.0 and 9.0 were chosen as cutoff values, 97 percent |
| Spontaneous remission occurs in 40 to 50 percent of | | | | of patients with UA who had a score equal to or less |
| UA patients, while about one-third develop rheumatoid | | | | than 5.0 did not develop RA, and a score of equal to |
| arthritis (RA). Rheumatologists must make a decision | | | | or greater than 9.0 was associated with progression |
| regarding whether to initiate disease modifying | | | | to RA in 84 percent of the patients. |
| anti-rheumatic drugs (DMARDS) immediately... or to | | | | "Because the prediction rule is accurate and can be |
| wait a bit. | | | | easily determined in daily clinical practice, the present |
| To investigate the question as to what could or should | | | | model is an important step forward in achieving |
| be done, researchers with the Early Arthritis Clinic at | | | | individualized treatment in patients with recent-onset |
| Leiden University Medical Center, The Netherlands, | | | | UA," notes chief spokesperson Dr. Tom W. J. Huizinga. |
| developed a formula to help determine whether | | | | "... we believe that the current model allows physicians |
| patients who present with UA are likely to progress to | | | | and patients to make an evidence-based choice |
| RA. | | | | regarding whether or not to initiate DMARDs, in the |
| They looked at a total of 1,700 arthritis patients. The | | | | majority of patients presenting with UA." |
| Leiden investigators then identified 570 patients with | | | | [van der Helm-van Mil AHM, le Cessie S, van Dongen |
| recent-onset UA and monitored their disease for one | | | | H, Breedveld FC, Toes REM, Huizinga TWJ. A |
| year. At the end of one year, 177 of the original UA | | | | Prediction Rule for Disease Outcome in Patients With |
| patients fulfilled the diagnostic criteria for RA and 150 | | | | Recent-Onset Undifferentiated Arthritis: How to Guide |
| had achieved remission; the remaining 94 had been | | | | Individual Treatment Decisions. Arthritis and |
| diagnosed with another arthritic condition. | | | | Rheumatism. 2007: 57 (2).] |
| Through a combination of questionnaires, physical | | | | Authors note: A version of this prediction scale is |
| examination, and blood samples, the team identified 9 | | | | already used by practitioners in the United States. By |
| clinical variables with independent predictive value for | | | | taking into consideration multiple variables, a |
| RA: gender, age, localization of symptoms, morning | | | | rheumatologist can usually arrive at a decision about |
| stiffness, the tender joint count, the swollen joint count, | | | | whether to start DMARD therapy or not. One |
| the C-reactive protein level, rheumatoid factor positivity, | | | | measure that was omitted from the Dutch study that |
| and the presence of anti-cyclic citrullinated peptide | | | | we often use in the U.S. is the use of an imaging |
| antibodies. | | | | procedure such as magnetic resonance imaging (MRI) |
| They then created a prediction scoring system | | | | or ultrasound. These imaging procedures are invaluable |
| The prediction score, ranging from 0 to 14, was | | | | for early detection of inflammatory damage (diagnosis) |
| calculated for every patient in the group, with a higher | | | | and staging. |
| score indicating a greater risk of developing RA. None | | | | We do know that the earlier treatment is started, the |
| of the patients who had a prediction score of less than | | | | more likely a patient will achieve remission. We also |
| 3 progressed to RA during the year-long observation. | | | | know that the more aggressive we are at the |
| In contrast, all of the patients who had a prediction | | | | beginning of RA, the more likely we are to avoid |
| score of 11 or greater progressed to RA. Among the | | | | permanent irreparable damage. On the flip side, the |
| patients with scores between 4 and 10 who | | | | use of strong DMARD therapy or biologic therapy |
| experienced progression to RA, the frequency of such | | | | should be tempered with the knowledge that these |
| progression increased with rising scores. | | | | drugs do have potentially severe side effects. |