van de Stadt et al reported a clinical prediction rule for a seropositive patient with arthralgia. This can help determine the risk of the patient progressing to arthritis. The authors are from Jan van Breemen Research Institute/Reade and VU Iniversity in Amsterdam.
Patient selection: seropositive arthralgia without arthritis; either rheumatoid factor IgM (RF) or anticyclic citrullinated peptide (aCCP) antibodies positive
Parameters:
(1) family history of rheumatoid arthritis in a first degree relative
(2) alcohol use
(3) duration of symptoms in months
(4) intermittent symptoms
(5) arthralgia in upper and lower extremities
(6) pain on 10 cm VAS
(7) morning stiffness in hours
(8) history of swollen joints
(9) antibody results
|
Parameter
|
Finding
|
Points
|
|
family history RA
|
absent
|
0
|
|
|
present
|
1
|
|
alcohol use
|
no
|
1
|
|
|
yes
|
0
|
|
duration of symptoms
|
< 12 months
|
1
|
|
|
>= 12 months
|
0
|
|
intermittent symptoms
|
absent
|
0
|
|
|
present
|
1
|
|
arthralgia in upper and lower extremities
|
no
|
0
|
|
|
yes
|
1
|
|
pain on VAS scale
|
< 50 mm (5 cm)
|
0
|
|
|
>= 50 mm (5 cm)
|
2
|
|
morning stiffness
|
< 1 hours
|
0
|
|
|
>= 1 hours
|
1
|
|
history of swollen joints
|
no
|
0
|
|
|
yes
|
1
|
|
antibody results
|
IgM RF positive; aCCP negative
|
0
|
|
|
IgM RF negative; aCCP low positive
|
2
|
|
|
IgM RF negative; aCCO high positive
|
3
|
|
|
both positive
|
4
|
where:
• A high positive aCCP was >= 3 times the upper limit of the reference range;
• A low positive aCCP was 1.01 to 2.99 times the upper limit of the reference range.
score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 13
• The higher the score the greater the risk of developing rheumatoid arthritis.
|
Score
|
Risk
|
Percent Arthritis in 5 Years
|
|
0 to 4
|
low
|
12%
|
|
5 or 6
|
intermediate
|
43%
|
|
7 to 13
|
high
|
81%
|
Performance:
• The area under the ROC curve at 5 years was 0.82.
