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    Model May Predict Rheumatoid Arthritis

    New Assessment Could Identify Which Arthritis Patients Need Aggressive Treatment
    By
    WebMD Health News
    Reviewed by Louise Chang, MD

    Jan. 30, 2007 -- A new prediction model developed in the Netherlands may make it easier for doctors to identify which arthritis patients need early, aggressive treatment and which do not.

    It is now clear that the best strategy for preventing potentially crippling joint damage in patients with rheumatoid arthritis is very early, aggressive treatment with a potentially toxic combination of drugs.

    But not all patients with arthritis have the progressive form of the disease.

    Studies suggest that pain and stiffness symptoms resolve on their own in time in as many as half of newly diagnosed patients with undifferentiated arthritis. Undifferentiated arthritis is arthritis that doesn't meet criteria for a more specific type.

    But about a third of undifferentiated arthritis patients end up with a diagnosis of rheumatoid arthritis, an autoimmune disease that affects joints and other parts of the body.

    In an effort to help guide treatment decisions, researchers in the Netherlands have developed a model for predicting a patient’s rheumatoid arthritis risk. The research is published in the February issue of Arthritis and Rheumatism.

    “This model would be very easy to adapt to clinical practice, because it is based on assessments rheumatologists already make,” researcher Annette van der Helm-van Mil, MD, PhD, tells WebMD.

    Model Identified Rheumatoid Arthritis Early

    The model was developed using data from 570 newly diagnosed patients with undifferentiated arthritis who were followed for a year.

    During that time, 177 were diagnosed with rheumatoid arthritis, while the remaining 393 either achieved remission, did not progress, or were diagnosed with other rheumatologic diseases.

    Using a combination of questionnaires, physical examinations, and blood samples, van der Helm-van Mil and her colleagues from the Leiden University Medical Center developed their nine-point model.

    Rheumatoid Arthritis Danger Signs

    Important predictive variables included a patient’s age, sex (most rheumatoid arthritis patients are women), number of tender joints and swollen joints, and certain symptoms characteristic of rheumatoid arthritis -- such as morning stiffness and location of affected joints.

    Other tests, including blood tests for C-reactive protein level and rheumatoid factor, were also included in the model.

    Based on the assessments, the researchers came up with a 14-point predictive score, with 0 being the lowest likelihood of progression to rheumatoid arthritis and 14 representing the highest likelihood.

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