Abstract
Background: Arthralgia often predates development of rheumatoid arthritis (RA). A set of joint symptoms commonly found in patients during their transition from arthralgia to RA, has been recently proposed.Aim: To combine clinical and serological markers and to improve recognition of imminent rheumatoid arthritis (RA) among patients with arthralgia.Methods: The total of 1,743 first-visit patients attending the rheumatology ward in Gothenburg for joint symptoms were identified during 12 consecutive months. Among those, 63 patients were classified as RA, 73 had undifferentiated arthritis and 180 had unexplained arthralgia. New RA cases, which prospectively developed during 48 months, comprised the preclinical (pre) RA group. The joint symptoms of the first-visit were analyzed aiming to distinguish patients with arthralgia and arthritis, and patients with pre-RA, who later developed the disease. The receiver operating characteristics curves were constructed. In the model, symptoms with the odds ratio >2.0 between the arthralgia and pre-RA were combined with information about RA-specific antibodies, C-reactive protein (CRP), and survivin in serum.Results: The proposed set of clinical symptoms distinguished the arthralgia patients from RA and pre-RA. Presence of survivin in serum showed strong association with clinical joint symptoms in arthralgia. A combination of symptoms in several small joint areas, increasing number of joints with symptoms, and patient's experience of swelling in small hand joints at the first visit identified pre-RA cases with 93% specificity. Grouping those symptoms with information about survivin, RA-specific antibodies, and CRP (or gender) in the final algorithm achieved 91% specificity and 55.2% of positive prediction for transition from arthralgia to RA.Conclusion: Clinical and serological parameters in combination aid recognition of imminent RA among arthralgia patients with appropriate sensitivity.
Highlights
Patients with musculoskeletal complains comprise the major part of visitors in general medical practice
Symptoms with the odds ratio >2.0 between the arthralgia and pre-rheumatoid arthritis (RA) were combined with information about RA-specific antibodies, C-reactive protein (CRP), and survivin in serum
In a recent population-based study within two university cities in Sweden, we demonstrated that measurement of survivin individually or in combination with RA-specific antibodies improves estimation of RA risk and prospectively predicts RA development in patients with arthralgia [53]
Summary
Patients with musculoskeletal complains comprise the major part of visitors in general medical practice. Studies of the recent years convincingly showed that early recruitment of RA patients from general clinical practice and initiation of anti-rheumatic treatment improved health outcomes, saved the quality adjusted life years [5], and slowed down irreversible consequences of arthritis [6,7,8,9]. Development of musculoskeletal symptoms, as arthralgia or tendinitis, often precedes clinical arthritis. Specific characteristic of musculoskeletal complains may give an opportunity to clinically identify the individuals at risk for progression to RA. The EULAR working group has recently summarized the expertise gained by rheumatologists and presented a set of parameters defining clinically suspect arthralgia [17]. The set of parameters was developed by the modified Delphi consensus approach where the clinical expertise was the reference. A set of joint symptoms commonly found in patients during their transition from arthralgia to RA, has been recently proposed
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