Risk of Rheumatoid Arthritis (RA) - Medical Algorithm

Description

Nell et al developed a decision tree based on serologic testing that can identify a patient with early arthritis who is at risk for developing rheumatoid arthritis (RA) with erosive disease. This can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from the University of Vienna.

Serologic tests:

(1) rheumatoid factor (RF) in U per mL (> 20 U/mL positive)

(2) antibodies to cyclic citrullinated peptide (anti-CCP, positive if > 5 arbitrary units)

(3) anti-RA33 (targets ribonucleoprotein A2)

Time of initial assessment: < 3 months since onset of symptoms

RF	Anti-CCP	Anti-RA33	Final Diagnosis RA
>= 50 U/mL	NA	NA	45%, high risk of developing RA, high risk erosive disease
< 50 U/mL	positive	NA	14%, high risk of developing RA, high risk erosive disease
< 50 U/mL	negative	positive	13%, moderate risk of developing RA, good prognosis
< 50 U/mL	negative	negative	28%, low risk of developing RA, excellent prognosis

RF	Anti-CCP	Anti-RA33	Final Diagnosis not RA
>= 50 U/mL	NA	NA	4%,
< 50 U/mL	positive	NA	2%
< 50 U/mL	negative	positive	9%
< 50 U/mL	negative	negative	85%

Performance

Test	Sensitivity for RA	Specificity for RA
RF positive (> 20 U/mL)	55%	89%
RF high titer (>= 50 U/mL)	45%	96%
anti-CCP positive	41%	98%
anti-RA33	28%	90%

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Description

Specialty

Objective

ICD-10

Decision Tree of Nell et al for Identifying the Risk of Developing Erosive Disease in a Patient with Early Arthritis

Purpose: To evaluate a patient with early rheumatoid arthritis for the risk

Description

Specialty

Objective

ICD-10