EULAR definition of “arthralgia suspicious for progression to rheumatoid arthritis” in a large cohort of patients included in a program for rapid diagnosis: role of auto-antibodies and ultrasound

Ruta, Santiago; Prado, Einer Sanchez; Chichande, Jessica Torres; Alvaro, Rosaria; Salvatori, Facundo; Magri, Sebastián; Salinas, Rodrigo García

doi:10.1007/s10067-019-04855-0

Cited by 29 publications

(15 citation statements)

References 24 publications

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“…It also suggests that anti-CCP2 is the most powerful of the three autoantibodies to predict arthritis onset, although it should be borne in mind that 50% of ACPA positive risk arthralgia patients did not develop arthritis within 2 years. A recent study from Argentina, which prospectively evaluated patients with hand arthralgia regardless of autoantibody status, similarly found low progression rates among seronegative patients, and considerably increased risk among those positive for RF or ACPA (assay not specified) (101).…”

Section: Autoantibodies Before Ra Diagnosismentioning

confidence: 90%

Autoantibodies in Rheumatoid Arthritis – Laboratory and Clinical Perspectives

2021

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Measurement of two groups of autoantibodies, rheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA) have gained increasing significance in the diagnosis and classification of rheumatoid arthritis (RA) over the last 65 years. Despite this rising importance of autoimmune serology in RA, there is a palpable lack of harmonization between different commercial RF and ACPA tests. While a minimal diagnostic specificity has been defined for RF tests, which almost always are related to an international reference preparation, neither of this applies to ACPA. Especially assays with low diagnostic specificity are associated with very low positive predictive values or post-test probabilities in real world settings. In this review we focus on issues of practical bearing for the clinical physician diagnosing patients who potentially have RA, or treating patients diagnosed with RA. We advocate that all clinically used assays for RF and ACPA should be aligned to a common diagnostic specificity of 98-99% compared to healthy controls. This high and rather narrow interval corresponds to the diagnostic specificity seen for many commercial ACPA tests, and represents a specificity that is higher than what is customary for most RF assays. Data on antibody occurrence harmonized in this way should be accompanied by test result-specific likelihood ratios for the target diagnosis RA on an ordinal or interval scale, which will provide the clinical physician with more granular and richer information than merely relating numerical values to a single cut-off point. As many physicians today are used to evaluate autoantibodies as positive or negative on a nominal scale, the introduction of test result-specific likelihood ratios will require a change in clinical mindset. We also discuss the use of autoantibodies to prognosticate future arthritis development in at-risk patients as well as predict severe disease course and outcome of pharmacological treatment.

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Section: Autoantibodies Before Ra Diagnosismentioning

confidence: 90%

Autoantibodies in Rheumatoid Arthritis – Laboratory and Clinical Perspectives

2021

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“…Thus, they concluded that US can be used as a predictor for the evolution to RA or other inflammatory arthritis in ACPA-negative patients presenting polyarthralgia. Recently, Ruta et al [ 19 ] investigated the performance of the EULAR definition of arthralgia suspicious for progression to RA in a large cohort of 465 patients with hand arthralgias. They identified the presence of PD in at least one joint as an independent predictor towards RA development ( OR 117.4, 95% CI 8.8–1553), as well as RF, ACPA and difficulty with making a fist.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound in clinically suspect arthralgia: the role of power Doppler to predict rheumatoid arthritis development

et al. 2021

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Objective To determine the usefulness of power Doppler (PD) ultrasound (US) to predict rheumatoid arthritis (RA) development in patients with clinically suspect arthralgia (CSA). Methods Retrospective analysis of a US unit cohort over a 1-year period. Patients with CSA and no previous diagnosis of inflammatory arthritis (IA) were included for analysis. All underwent bilateral US examination of the hands and/or feet according to the EULAR guidelines. Active US inflammation was defined as PD synovitis and/or tenosynovitis ≥1 at any location. RA diagnosis according to clinician criteria 6 months after the US examination was checked. Univariate and multivariate logistic regression models were employed to investigate possible predictive factors of RA development. Results A total of 110 CSA patients (80 females, mean age 53.6 years) were included for analysis. After 6 months of follow-up, 14 (12.7%) developed RA and 34 (30.9%) IA. US active inflammation was present in 38 (34.5%) patients (28.2% showed PD synovitis and 18.2% PD tenosynovitis). Multivariate analysis showed that ACPA (OR 1.0003; 95% CI 1.002–1.006) and ESR (OR 1.054; 95% CI 1.016–1.094) were significantly associated with the detection of US active inflammation at baseline. Only PD tenosynovitis was found to be an independent predictive factor of an evolution towards RA (OR 6.982; 95% CI 1.106–44.057) and IA (OR 5.360; 95% CI 1.012–28.390). Conclusion US is able to detect features of subclinical inflammation in CSA patients, especially in those with higher ESR and ACPA values. Only PD tenosynovitis at baseline US assessment was found to be an independent predictor of RA and IA development in CSA patients.

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“…Categorisation of the timeline between symptoms, swelling and TtE should decrease analysis bias. Also, as Leiden, quite at-RA GP ve been offered guidance for early referral since 2013 (9) (10). This may explain the big difference in RA diagnosis at first visit between the EAC (36%) and the ESPOIR cohort (78%).…”

Section: I Ramentioning

confidence: 99%