Visser et al developed a model for predicting outcome in a patient presenting with the diagnosis of arthritis. This can help identify those patients likely to have persistent and erosive disease, so that therapy can be started early. The authors are from Leiden University in The Netherlands.
NOTE: While the title specifies rheumatoid arthritis, Table 2 (page 360) indicates that 10 different kinds of inflammatory arthritis were included in the study.
Parameters:
(1) symptom duration at first visit
(2) duration of morning stiffness
(3) number of joints affected by arthritis
(4) bilateral compression pain in the metatarsophalangeal (MTP) joints
(5) rheumatoid factor (RF)
(6) anti-cyclic citrullinated peptide antibody (anti-CCP)
(7) presence of erosions in hands and/or feet in radiographs
Scores calculated:
(1) Score 1: persistent vs self-limited arthritis
(2) Score 2: if persistent, erosive vs nonerosive arthritis
Parameter |
Finding |
Points for Score 1 |
Points for Score 2 |
---|---|---|---|
symptom duration |
< 6 weeks |
0 |
0 |
|
>= 6 weeks but < 6 months |
2 |
0 |
|
>= 6 months |
3 |
0 |
duration of morning stiffness |
< 1 hour |
0 |
0 |
|
>= 1 hour |
1 |
1 |
number of joint groups with arthritis |
1 or 2 |
0 |
0 |
|
>= 3 |
1 |
1 |
compression pain in MTP joints |
none |
0 |
0 |
|
unilateral |
0 |
0 |
|
bilateral |
1 |
2 |
IgM Rheumatoid Factor |
< 5 IU |
0 |
0 |
|
>= 5 IU |
2 |
2 |
anti-CCP |
< 92 IU |
0 |
0 |
|
>= 92 IU |
3 |
3 |
erosions in hands OR feet in radiographs |
absent |
0 |
0 |
|
present |
2 |
"infinite" |
where:
• "Infinite" can be replaced by any number >=10 for implementation.
Findings |
Odds Ratio for Persistent vs Nonpersistent |
Odds Ratio for Erosive vs Nonerosive if Persistent |
---|---|---|
symptom duration >= 6 weeks but < 6 months |
2.49 |
0.96 |
symptom duration >= 6 months |
5.49 |
1.44 |
duration of morning stiffness >= 1 hour |
1.96 |
1.96 |
number of joint groups with arthritis >= 3 groups |
1.73 |
1.73 |
bilateral compression pain in MTP joints |
1.65 |
3.78 |
IgM Rheumatoid Factor >= 5 IU |
2.99 |
2.99 |
anti-CCP >= 92 IU |
4.58 |
4.58 |
erosions in hands OR feet in radiographs |
2.75 |
"infinite" |
from Table 3, page 360
score 1 for predicting persistent vs self-limited arthritis =
= SUM(score 1 points for 7 parameters)
score 2 for predicting erosive vs nonerosive arthritis if persistent =
= SUM(score 2 points for 7 parameters)
Interpretation:
• minimum scores: 0
• maximum score 1: 13
• maximum score 2: "infinity"
Score 1 |
Probability of Persistence |
---|---|
0 |
10% |
1 |
15% |
2 |
23% |
3 |
34% |
4 |
46% |
5 |
59% |
6 |
71% |
7 |
80% |
8 |
87% |
9 |
92% |
10 |
95% |
11 |
97% |
12 |
98% |
13 |
99% |
from Table 4, page 360
Score 2 |
Probability of Erosions If Persistent |
---|---|
0 |
10% |
1 |
16% |
2 |
25% |
3 |
38% |
4 |
52% |
5 |
66% |
6 |
78% |
7 |
86% |
8 |
92% |
9 |
95% |
"infinite" |
100% |
Performance:
• The area under the ROC curve was 0.84 for self-limited vs persistent arthritis.
• The area under the ROC curve was 0.91 for nonerosive vs erosive arthritis if persistent.
• The performance was better than the ACR 1987 classification criteria for rheumatoid arthritis.
Limitations:
• The scores need to be validated in other clinics.
Purpose: To evaluate a patient presenting with early arthritis for features predicting persistence and risk of erosive change.
Specialty: Immunology/Rheumatology, Surgery, orthopedic, Infectious Diseases
Objective: clinical diagnosis, including family history for genetics, laboratory tests, prevention
ICD-10: M05, M06,