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.
- Early Rheumatoid Arthritis
- Rheumatoid Arthritis
- Outcomes research
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Handling editor Hans WJ Bijlsma
Contributors All authors contributed substantially to the conception and design of the work and acquisition and interpretation of the data. HWvS, AHMvdH-vM and RLL additionally analysed the data and drafted the initial version of the manuscript. All other authors revised the manuscript critically for important intellectual content and all authors gave approval of the final version to be published.
Funding This taskforce developing the presented definition was financially supported by EULAR Standing Committee on Clinical Affairs (ESCCA).
Competing interests None declared.
Patient consent Obtained.
Ethics approval The medical ethics committee of the Leiden University Medical Centre obtained approval for the patient information used in phase I and phase II. In phase III, approval was obtained, if necessary, according to the local guidelines of the participating centres.
Provenance and peer review Not commissioned; externally peer reviewed.
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