van Steenbergen et al reported criteria for identifying a patient with arthralgia who is at risk for progression to rheumatoid arthritis. The criteria can help to identify a patient who may benefit from closer monitoring. The authors are from multiple institutions in Europe and participate in EULAR.
Patient selection: arthralgia without clinical arthritis
Findings:
(1) duration of arthralgia less than one year (recent onset)
(2) symptoms involve the MCP joints
(3) duration of morning stiffness >= 60 minutes
(4) most severe symptoms are present in the early morning
(5) presence of a first degree relative with rheumatoid arthritis
(6) difficulty in making a fist
(7) positive squeeze test of MCP joints
Exclusion: another diagnosis for the arthralgias
number of parameters =
= SUM(number of findings)
Interpretation:
• minimum number of findings: 0
• maximum number of findings: 7
• A number >=3 had the highest Youden index (sensitivity 90%, specificity 74%) with a number >= 2 close behind (sensitivity 96%, specificity 54%)..
• A number >= 4 had a specificity of 94%.
Performance:
• The area under the ROC curve is 0.92.
