Currently, there are no data or recommendations on how often symptomatic patients should be followed, she said, but emphasized the importance given data that show that recurrent symptoms contribute to the risk of developing RA. To help clinicians predict which patients with arthralgia will develop RA, she referred them to a prediction tool developed from the Amsterdam Arthralgia Cohort.6 The tool uses nine variables that are scored (range, 0–13) to predict RA risk. The nine variables include RA in a first-degree family member, alcohol non-use, duration of symptoms less than 12 months, presence of intermittent symptoms, arthralgia in upper and lower extremities, visual analogue scale pain ≥50, presence of morning stiffness ≥1 hour, history of swollen joints as reported by the patient, and antibody status. Patients are then categorized into three risk groups: low (0–4 points), intermediate (5–6 points), and high risk (7–13 points).
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Explore This IssueFebruary 2014
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Overall, she emphasized the need for studies to evaluate prevention in patients at risk of developing RA. “In general, a combination of symptoms and autoantibodies yields the highest risk for RA and may be the most feasible population to target for a prevention intervention,” she said.
Mary Beth Nierengarten is a freelance medical journalist based in St. Paul, Minn.
Key References on Evidence for Lung Inflammation and RA
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- Demoruelle MK, Weisman MH, Simonian PL, Lynch DA, Sachs PB, Pedraza IF, et al. Brief report: Airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: Early injury or initiating site of autoimmunity. Arthritis Rheum. 2012; 64:1756-1761.
- Reynisdottir G, Karimi R, Joshua V, Olsen H, Hensvold AH, Harju, A, et al. Structural lung changes and local anti-citrulline immunity are early features of anti-citrullinated-proteins antibodies positive rheumatoid arthritis. Arthritis Rheum. 2013 Oct 21. doi: 10.1002/art.38201. [Epub ahead of print]
- Scher JU, Sczesnak A, Longman RS, Segata N, Ubeda C, Bielski C. Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis. Elife. 2013;2.pii:e01202.
- Raza K, Saber TP, Kvein TK, Tak PP, Gerlag DM. Timing the therapeutic window of opportunity in early rheumatoid arthritis: Proposal for definitions of disease duration in clinical trails. Ann Rheum Dis. 2012;71:1921-1923.
- Smolik I, Robinson DB, Bernstein CN, El-Gabalawy HS. First-degree relatives of patients with rheumatoid arthritis exhibit high prevalence of joint symptoms. J Rheumatol. 2013;40:818-824.
- Krabben A, Stomp W, van der Heijde DM, van Nies JA, Bloem JL, Huizinga TW, et al. MRI of hand and foot joints of patients with anticitrullinated peptide antibody positive arthralgia without clinical arthritis. Ann Rheum Dis. 2013;72:1540-1544.
- Kleyer A, Finzel S, Rech J, Manger B, Krieter M, Faustini F, et al. Bone loss before the clinical onset of rheumatoid arthritis in subjects with anticitrullinated protein antibodies. Ann Rheum Dis. 2013 Mar 21 [Epub ahead of print].
- van de Stadt LA, Witte BI, Bos WH, van Schaardenburg D. A prediction rule for the development of arthritis in seropositive arthralgia patients. Ann Rheum Dis. 2013; 72:1920-1926.