Slightly over half of patients with initially undefined inflammatory polyarthritis will eventually develop persistent or relapsing diseases like RA.
The predictors of evolution to RA are: female, more tender joints, poorer functional status, being obese, hypertensive or depressed.
Appropriate use of the EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis
EULAR taskforce identified 7 factors, when found in combination, to be predictive of joint pains evolving into RA. They are:
1) symptom duration <1 year
7) positive squeeze test of MCP joints.
The Leeds group suggested complementing these 7 clinical factors with laboratory (anti-CCP) and ultrasound.
EULAR clarified that the 7 pointers were not designed for primary care as a referral tool, even though it sounds useful enough, given that no special test/equipment/skill was required in the assessment. If EULAR's target is the rheumatologist, then the latter has deeper skills to detect "subclinical synovitis" than having to rely on this checklist. Methinks the Leeds group has a valid point.
But I have another trick up my sleeve: a therapeutic trial.
Diagnostic value of a 3-day course of prednisolone in patients with possible rheumatoid arthritis – the TryCort study
Been doing this diagnostic "trial of steroid" for almost 2 decades.
I typically prescribe Prednisolone 5-10mg twice daily for a week, off it for another week, and then review.