ten Brinck et al reported a clinical rule for early recognition of inflammatory arthritis. A patient with possible early inflammatory arthritis should be referred to a rheumatologist in 3-6 weeks after onset. the authors are from Leiden University in The Netherlands.
Patient selection: recent onset of arthritis
Parameter:
(1) sex
(2) age in years
(3) duration of symptoms in weeks
(4) duration of morning stiffness in minutes
(5) number of patient-reported painful joints
(6) number of patient-reported joint swelling
(7) making a fist
Parameter |
Finding |
Points |
sex |
male |
0.5 |
|
female |
0 |
age in years |
< 60 years |
0 |
|
>= 60 years |
0.5 |
duration of symptoms |
< 6 weeks |
1.5 |
|
6 to 51.9 |
1 |
|
>= 52 |
0 |
morning stiffness |
<= 60 minutes |
0 |
|
> 60 minutes |
0.5 |
number of painful joints |
0 |
0 |
|
1 to 3 |
2.5 |
|
>= 4 |
1.5 |
number of swollen joints |
0 |
0 |
|
>= 1 |
1.5 |
making a fist |
not difficult |
0 |
|
difficult |
0.5 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7.5
• The higher the score the greater the risk of early inflammatory arthritis.
Score |
Risk of Inflammatory Arthritis |
0 |
0% |
1 |
2% |
2 |
8% |
3 |
14% |
4 |
30% |
5 |
49% |
6 |
71% |
7 |
87% |
Performance:
• The area under the ROC curve is 0.74 in derivation set and 0.71 in validation set.
Specialty: Immunology/Rheumatology