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How to predict prognosis in early rheumatoid arthritis

https://doi.org/10.1016/j.berh.2004.08.008Get rights and content

In early rheumatoid arthritis (RA), the objectives of therapeutic strategies are to obtain remission and prevent joint destruction as early as possible. These goals may be reached with conventional disease-modifying antirheumatic drugs (DMARDs) or with biological agents. In clinical practice, initial treatments are usually chosen according to the degree of disease activity at baseline, and adapted according to a step-up strategy. A more elegant therapeutic approach would be to choose the most appropriate treatment based on the prognosis of RA. Therefore, prognostic stratification could improve the relative roles and benefits of initial DMARD or biological therapy for early RA. For RA with a severe prognosis, a combination of DMARDs or biologicals could be initiated as the first-line therapy. However, we need to know how to predict outcome in early RA for this type of strategy. This review attempts to answer this question by reporting the most reliable prognostic factors and some predictive models proposed for classification into benign, mild and severe RA.

Section snippets

Why is it important to predict prognosis in early ra?

RA is a very heterogeneous disease, the outcome of which is difficult to predict. Some RA patients (30%) do not develop any erosions, even after considerable disease duration, but the majority of patients do have bone erosions. Radiological damage occurs early in disease; approximately 30% of patients will develop bone erosions within 1 year of disease onset and this percentage increases to 70% by 3 years.4 Radiographic progression in RA can follow a linear or a sigmoid curve, but is more rapid

What are the most reliable markers to predict prognosis in early ra?

Many prognostic factors have been described for RA based on results obtained from several longitudinal studies performed in Europe and North America with different cohorts of early RA patients.20 They include demographic, genetic, clinical, biological and radiological factors, but only a few can really be considered as prognostic markers.

Can we really predict prognosis of early ra?

Prognostic scores have been developed to classify patients according to the severity of joint destruction in low, mild and severe erosive RA. The different predictive scores regroup at least two prognostic factors among the most reliable markers present at baseline or at 1 year. The predictive models are calculated from logistic regression analysis Unfortunately, in most studies, these calculated prognostic scores have not been retested on similar, independent samples to confirm their

Conclusion

In conclusion, stratification of early RA into benign, moderate and severe prognosis is important in order to propose a tailormade therapy. RA prognosis is based on the presence or absence of different prognostic factors that have been identified from longitudinal studies. Some of these factors are interobserver independent, whereas others are subjective and variable. The actual method to assess the prognosis of early RA is not very profitable because it only predicts the severe outcome for a

Summary

Radiological damage and disability are the two main complications of RA. The most reliable prognostic factors of radiological damage are high ESR or CRP, the presence and titre of RF and anti-CCP at baseline, the HLA-DRB1*04 SE alleles, especially homozygotic and HLA-DRB1*0401 allele subtype, and early erosions or radiological score at disease onset. The HAQ score is the best prognostic marker for disability and work loss. Several predictive models for early RA have been developed but not

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