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Abstract
Background New ACR/EULAR classification criteria for RA were developed in response to the criticism of existing 1987 ACR criteria due to insufficient sensitivity in early disease. According the new criteria a score of ≥6 is indicative of the presence of RA. But one limitation of these new criteria is a lack of factors with imaging techniques for a better identification of patients with high-risk to devolope erosive course.
Objectives There are two other prediction models for development of RA, the Helm-van Mil-Score without imaging techniques and the Visser-Score with detection of early erosions by X-ray. The calculated scores correspond to the probability of persistent or self-limiting and non-erosive or erosive course. The aim was to compare the new ACR/EULAR criteria with two other long existing predictive scores regarding cut-off for erosive course.
Methods 95 Patients with early arthritis were observed and classified by new ACR/EULAR criteria, Helm-van Mil-Score (HvM) and Visser-Score. The treatment decision was made by subjective assessment of the severity. 35 patients have ACR/EULAR-Score ≥6, 33 patients have HvM-Score ≥8 (positive prediction of persistence 84%) and 27 patients with a prediction of persistence ≥80% measured by Visser-Score. All patients will be monitored in order to differentiate in the course by over-treated and under-treated regarding different prediction scores.
Results There are differences in prediction values for many patients with undifferentiated Arthritis. The pictures show the different cut-offs for assessing the persistence of arthritis. According to the ACR/EULAR criteria, 35 patients a treatment would be supplied with DMARDs, according to Helm-van Mil 33 and after Visser score only 27. It should be clarified in the course of the investigation which patients benefit from treatment actually.
Conclusions There is a difference of 8 patients between ACR/EULAR criteria of RA and theultrasound-assistedVisser-Score. The at least one year follow up will show how many patients develop a RA and how many of them need an early anti-inflammatory therapy with DMARDs. The goal is to treat as many patients as early as adequate, while the number of over-treated patients on low to keep.
Disclosure of Interest None Declared