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Nomogram for Predicting Functional Outcome in Patient with Early Rheumatoid Arthritis

Purpose: To evaluate a patient with early rheumatoid arthritis for the risk of moderate-to-severe functional impairment using the nomogram of Bansback et al.

Description

Bansback et al developed a nomogram for predicting functional outcome in a patient with early rheumatoid arthritis. This can help identify a patient who may benefit from more aggressive management. The authors are from City Hospital, St. Albans, United Kingdom


Endpoint: probability of moderate to severe functional outcome

 

Parameters:

(1) Carstairs deprivation index

(2) functional grade at baseline

(3) functional grade at 1 year

(4) HAQ at baseline

(5) HAQ at 1 year

(6) hemoglobin at baseline in g/L

(7) DAS28 at 1 year

(8) Larsen index at baseline

 

Parameter

Finding

Points

Carstairs index

1

9.4

 

2

0

 

3

22.7

 

4

30

 

5

35

functional grade at baseline

I

0

 

II, III or IV

22

functional grade at 1 year

I

0

 

II

25.6

 

III or IV

64.3

 

points for HAQ at baseline

= (HAQ at baseline) * 20

 

points for HAQ at 1 year

= (HAQ at 1 year) * 33.3

 

Hemoglobin

Points

<= 80 g/L

0

80.01 - 180 g/L

(0.5649 * (hemoglobin)) - 45.192

> 180 g/L

56.5

 

points for Larsen at baseline =

= (Larsen score) * 0.4667

 

points for DAS28 at 1 year =

= (5.122 * ((DAS28) - 1))

 

total score =

= SUM(points for all 8 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 400

• The higher the score the greater the risk of a moderate to severe impairment.

 

Total Score

Probability of Moderate to Severe Impairment

< 49 points

< 5%

49 to 125

(0.000025 * ((points)^2)) - (0.00168 * (points)) + 0.07262

125 to 210

(0.005581 * (points)) - 0.4444

210 to 358

(-0.000057 * ((points)^2)) + (0.0218 * (points)) - 1.803

> 358

> 99%

 


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Specialty

Objective

ICD-10