Department of Rheumatology, Jan van Breemen Research Institute|Reade, , Amsterdam, The Netherlands.
Ann Rheum Dis. 2013 Dec;72(12):1920-6. doi: 10.1136/annrheumdis-2012-202127. Epub 2012 Nov 23.
To predict the development of arthritis in anticyclic citrullinated peptide antibodies and/or IgM rheumatoid factor positive (seropositive) arthralgia patients.
A prediction rule was developed using a prospective cohort of 374 seropositive arthralgia patients, followed for the development of arthritis. The model was created with backward stepwise Cox regression with 18 variables.
131 patients (35%) developed arthritis after a median of 12 months. The prediction model consisted of nine variables: Rheumatoid Arthritis in a first degree family member, alcohol non-use, duration of symptoms <12 months, presence of intermittent symptoms, arthralgia in upper and lower extremities, visual analogue scale pain ≥50, presence of morning stiffness ≥1 h, history of swollen joints as reported by the patient and antibody status. A simplified prediction rule was made ranging from 0 to 13 points. The area under the curve value (95% CI) of this prediction rule was 0.82 (0.75-0.89) after 5 years. Harrell's C (95% CI) was 0.78 (0.73-0.84). Patients could be categorised in three risk groups: low (0-4 points), intermediate (5-6 points) and high risk (7-13 points). With the low risk group as a reference, the intermediate risk group had a hazard ratio (HR; 95% CI) of 4.52 (2.42-8.77) and the high risk group had a HR of 14.86 (8.40-28.32).
In patients presenting with seropositive arthralgia, the risk of developing arthritis can be predicted. The prediction rule that was made in this patient group can help (1) to inform patients and (2) to select high-risk patients for intervention studies before clinical arthritis occurs.
预测抗环瓜氨酸肽抗体和/或 IgM 类风湿因子阳性（血清阳性）关节痛患者关节炎的发展。
使用前瞻性队列研究 374 例血清阳性关节痛患者，对关节炎的发展进行随访。使用向后逐步 Cox 回归对 18 个变量进行建模。
131 例患者（35%）在中位数为 12 个月后发生关节炎。预测模型由 9 个变量组成：一级亲属中有类风湿关节炎、不饮酒、症状持续时间<12 个月、间歇性症状存在、上下肢关节痛、视觉模拟评分疼痛≥50、晨僵持续时间≥1 小时、患者自述关节肿胀史和抗体状态。制定了一个简化的预测规则，范围为 0 到 13 分。该预测规则的曲线下面积值（95%CI）在 5 年内为 0.82（0.75-0.89）。哈雷尔氏 C（95%CI）为 0.78（0.73-0.84）。患者可分为三个风险组：低风险（0-4 分）、中风险（5-6 分）和高风险（7-13 分）。以低风险组为参照，中风险组的危险比（HR；95%CI）为 4.52（2.42-8.77），高风险组的 HR 为 14.86（8.40-28.32）。
在出现血清阳性关节痛的患者中，可以预测关节炎的发生风险。在该患者组中制定的预测规则可以帮助（1）告知患者，（2）在出现临床关节炎之前选择高危患者进行干预研究。
