BACKGROUND: During the transition to rheumatoid arthritis (RA) many patients pass through a phase characterised by the presence of symptoms without clinically apparent synovitis. These symptoms are not well-characterised. This taskforce aimed to define the clinical characteristics of patients with arthralgia who are considered at risk for RA by experts based on their clinical experience. METHODS: The taskforce consisted of 18 rheumatologists, 1 methodologist, 2 patients, 3 health professionals and 1 research fellow. The process had three phases. In phase I, a list of parameters considered characteristic for clinically suspect arthralgia (CSA) was derived; the most important parameters were selected by a three-phased Delphi approach. In phase II, the experts evaluated 50 existing patients on paper, classified them as CSA/no-CSA and indicated their level of confidence. A provisional set of parameters was derived. This was studied for validation in phase III, where all rheumatologists collected patients with and without CSA from their outpatient clinics. RESULTS: The comprehensive list consisted of 55 parameters, of which 16 were considered most important. A multivariable model based on the data from phase II identified seven relevant parameters: symptom duration <1 year, symptoms of metacarpophalangeal (MCP) joints, morning stiffness duration ≥60 min, most severe symptoms in early morning, first-degree relative with RA, difficulty with making a fist and positive squeeze test of MCP joints. In phase III, the combination of these parameters was accurate in identifying patients with arthralgia who were considered at risk of developing RA (area under the receiver operating characteristic curve 0.92, 95% CI 0.87 to 0.96). Test characteristics for different cut-off points were determined. CONCLUSIONS: A set of clinical characteristics for patients with arthralgia who are at risk of progression to RA was established.

Amsterdam Rheumatology and Immunology Center Amsterdam the Netherlands and Atrium Medical Center Heerlen The Netherlands

Amsterdam Rheumatology and immunology Center locations Reade and Academic Medical Center Amsterdam The Netherlands

DANBIO registry and Center for Rheumatology and Spine Diseases Centre of Head and Orthopaedics Rigshospitalet Copenhagen Denmark

Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Department of Internal Medicine 3 Division of Rheumatology Medical University Vienna Vienna Austria

Department of Internal Medicine 3 University of Erlangen Nuremberg Erlangen Germany

Department of Public Health and Clinical Medicine Rheumatology University Hospital Umeå Sweden

Department of Rheumatology 1st Faculty of Medicine Institute of Rheumatology Charles University Prague Czech Republic

Department of Rheumatology and Clinical Immunology University of Groningen University Medical Center Groningen The Netherlands

Department of Rheumatology and Internal Medicine Wroclaw Medical University Wroclaw Poland

Department of Rheumatology Diakonhjemmet Hospital Oslo Norway

Department of Rheumatology Erasmus University Medical Center Rotterdam The Netherlands

Department of Rheumatology Hospital Universitario La Paz IdiPaz Paseo de La Castellana Madrid Spain

Department of Rheumatology Leiden University Medical Center Leiden The Netherlands

Department of Rheumatology Montpellier University Hospital Montpellier France

Department of Rheumatology University of Debrecen Medical Center Debrecen Hungary

EULAR Standing Committee of People with Arthritis Rheumatism in Europe Zurich Switzerland

Independent Nurse Consultant North Devon UK

Institute of Physiotherapy School of Health Professions Zurich University of Applied Sciences Winterthur Switzerland

Queen Mary University of London Centre for Experimental Medicine and Rheumatology William Harvey Research Institute London UK

Rheumatology Department Center of Rheumatic Diseases Bucharest Romania

Rheumatology Department Centro Hospitalar de Lisboa Norte EPE Hospital de Santa Maria Lisbon Academic Medical Centre Lisbon Portugal

Rheumatology Research Group Institute of Inflammation and Ageing College of Medical and Dental Sciences University of Birmingham Birmingham UK

Rheumatology Research Unit Instituto de Medicina Molecular Faculdade de Medicina da Universidade de Lisboa Lisbon Portugal

Sandwell and West Birmingham Hospitals NHS Trust Birmingham UK

Ann Rheum Dis. 2017 Jun;76(6):e14. doi: 10.1136/annrheumdis-2016-210853. PubMed

Ann Rheum Dis. 2017 Jun;76(6):e15. doi: 10.1136/annrheumdis-2016-210859. PubMed

Ann Rheum Dis. 2017 Oct;76(10):e40. doi: 10.1136/annrheumdis-2017-211205. PubMed

Ann Rheum Dis. 2017 Oct;76(10):e41. doi: 10.1136/annrheumdis-2017-211230. PubMed

Citace poskytuje Crossref.org

Integrative non-pharmacological care for individuals at risk of rheumatoid arthritis