Predicting RA Development

Predictors of Progression in Early Inflammatory Polyarthritis

A substantial, but unclear, percentage of patients presenting with new onset inflammatory polyarthritis (IP) will spontaneously remit, while others may persist and develop rheumatoid arthritis (RA).

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.

Arthralgia That Might Progress to RA Defined by EULAR

A EULAR task force identified seven parameters that might predict future rheumatoid arthritis in patients who have joint pain without clinically apparent synovitis.

EULAR definition of arthralgia suspicious for progression to Rheumatoid Arthritis

Background During the transition to rheumatoid arthritis (RA) many patients pass through a phase characterised by the presence of symptoms without clinically apparent synovitis. These symptoms are not well-characterised. This taskforce aimed to define the clinical characteristics of patients with ar…

Identifying arthralgia suspicious for progression to rheumatoid arthritis

We read with interest the article by van Steenbergen et al 1 in which a definition for arthralgia suspicious for progression to rheumatoid arthritis (RA) was proposed. The authors used a three-phase Delphi exercise to crystallise the concept of clinically suspect arthralgia (CSA), which is inherentl…

Appropriate use of the EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis

We thank Mankia et al 1 for their interest in the European League Against Rheumatism (EULAR) definition of arthralgia suspicious for progression to rheumatoid arthritis (RA).2 The authors agree with the taskforce that derivation of criteria for imminent RA is an ambitious next step and that such cri…

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

2) symptoms of metacarpophalangeal (MCP) joints
3) morning stiffness duration ≥60 min
4) most severe symptoms in early morning
5) first-degree relative with RA
6) difficulty with making a fist

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.

In patients with tender and swollen finger joints, the differential diagnosis between rheumatoid arthritis (RA) and osteoarthritis (OA) of the hands can be initially difficult. This prospective study (the TryCort study) was performed to study the diagnostic value of prednisolone in differentiating b…

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.