Featured Research

from universities, journals, and other organizations

Predicting The Risk Of Rheumatoid Arthritis For Early Arthritis Patients

Date:
January 30, 2007
Source:
John Wiley & Sons, Inc.
Summary:
A wealth of research supports early aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) as the best course for preventing joint damage and avoiding the fate of a wheelchair. Still, the use of DMARDs, even the widely prescribed and generally safe methotrexate, brings the risk of liver damage and other serious complications.

Marked by chronic inflammation of the joints and tissue, rheumatoid arthritis (RA) is a painful and potentially disabling autoimmune disease. A wealth of research supports early aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) as the best course for preventing joint damage and avoiding the fate of a wheelchair. Still, the use of DMARDs, even the widely prescribed and generally safe methotrexate, brings the risk of liver damage and other serious complications.

Among those who seek out a doctor's help for joint pain and stiffness, the most common diagnosis is undifferentiated arthritis (UA), or arthritic symptoms that do not add up to a specific arthritic disease. Spontaneous remission occurs in 40 to 50 percent of UA sufferers, while about one-third develop RA. Physicians often face the tough choice of whether to initiate DMARD therapy immediately or to wait and see. To guide individual treatment decisions, researchers with the Early Arthritis Clinic at Leiden University Medical Center, The Netherlands, have found a formula to help determine whether patients who present with UA are likely to progress to RA. The February 2007 issue of Arthritis & Rheumatism features their simple, reliable prediction rule for disease outcome.

Starting with clinical data for over 1,700 arthritis patients, the Leiden team identified 570 patients with recent-onset UA and monitored their disease for one year. At the culmination of follow-up, 177 of the original UA patients fulfilled the diagnostic criteria for RA and 150 had achieved remission; the remaining 94 had been diagnosed with another rheumatologic disease. Through a combination of questionnaires, physical examination, and blood samples, the team identified 9 clinical variables with independent predictive value for RA: sex, age, localization of symptoms, morning stiffness, the tender joint count, the swollen joint count, the C-reactive protein level, rheumatoid factor positivity, and the presence of anti-cyclic citrullinated peptide antibodies. Then, using the area under the curve (AUC), the diagnostic performance of the prediction rule was evaluated.

A prediction score, ranging from 0 to 14, was calculated for every patient in the group, with a higher score indicating a greater risk of developing RA. None of the patients who had a prediction score of less than 3 progressed to RA during the year-long observation. In contrast, all of the patients who had a prediction score of 11 or greater did experience progression to RA. Among the patients with scores between 4 and 10 who experienced progression to RA, the frequency of such progression increased with rising scores.

The percentage of patients in whom RA developed was also assessed according to several cutoff values of the prediction score. For example, when the scores 5.0 and 9.0 were chosen as cutoff values, 97 percent of patients with UA who had a score equal to or less than 5.0 did not develop RA, and a score of equal to or greater than 9.0 was associated with progression to RA in 84 percent of the patients.

"Because the prediction rule is accurate and can be easily determined in daily clinical practice, the present model is an important step forward in achieving individualized treatment in patients with recent-onset UA," notes team spokesperson Dr. Tom W. J. Huizinga. "Although the validation cohort is relatively small and the current prediction rule should be evaluated in other early-arthritis cohorts, we believe that the current model allows physicians and patients to make an evidence-based choice regarding whether or not to initiate DMARDs, in the majority of patients presenting with UA."

Article: "A Prediction Rule for Disease Outcome in Patients With Recent-Onset Undifferentiated Arthritis: How to Guide Individual Treatment Decisions," Annette H.M. van der Helm-van Mil, Saskia le Cessie, Henrike van Dongen, Ferdinand C. Breedveld, Renι E. M. Toes, and Tom W. J. Huizinga, Arthritis & Rheumatism, February 2007; (DOI: 10.1002/art.22380)


Story Source:

The above story is based on materials provided by John Wiley & Sons, Inc.. Note: Materials may be edited for content and length.


Cite This Page:

John Wiley & Sons, Inc.. "Predicting The Risk Of Rheumatoid Arthritis For Early Arthritis Patients." ScienceDaily. ScienceDaily, 30 January 2007. <www.sciencedaily.com/releases/2007/01/070130085438.htm>.
John Wiley & Sons, Inc.. (2007, January 30). Predicting The Risk Of Rheumatoid Arthritis For Early Arthritis Patients. ScienceDaily. Retrieved July 26, 2014 from www.sciencedaily.com/releases/2007/01/070130085438.htm
John Wiley & Sons, Inc.. "Predicting The Risk Of Rheumatoid Arthritis For Early Arthritis Patients." ScienceDaily. www.sciencedaily.com/releases/2007/01/070130085438.htm (accessed July 26, 2014).

Share This




More Health & Medicine News

Saturday, July 26, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Beatings and Addiction: Pakistan Drug 'clinic' Tortures Patients

Beatings and Addiction: Pakistan Drug 'clinic' Tortures Patients

AFP (July 24, 2014) — A so-called drugs rehab 'clinic' is closed down in Pakistan after police find scores of ‘patients’ chained up alleging serial abuse. Duration 03:05 Video provided by AFP
Powered by NewsLook.com
Too Few Teens Receiving HPV Vaccination, CDC Says

Too Few Teens Receiving HPV Vaccination, CDC Says

Newsy (July 24, 2014) — The Centers for Disease Control and Prevention is blaming doctors for the low number of children being vaccinated for HPV. Video provided by Newsy
Powered by NewsLook.com
New Painkiller Designed To Discourage Abuse: Will It Work?

New Painkiller Designed To Discourage Abuse: Will It Work?

Newsy (July 24, 2014) — The FDA approved Targiniq ER on Wednesday, a painkiller designed to keep users from abusing it. Like any new medication, however, it has doubters. Video provided by Newsy
Powered by NewsLook.com
Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Newsy (July 24, 2014) — Sheik Umar Khan has treated many of the people infected in the Ebola outbreak, and now he's become one of them. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins