General practice

A simple algorithm to predict the development of radiological erosions in patients with early rheumatoid arthritis: prospective cohort study

^a Arthritis and Rheumatism Council Epidemiology Research Unit, University of Manchester Medical School, Manchester M13 9PT, ^b Norfolk Arthritis Register, St Michael's Hospital, Aylsham, Norfolk

Correspondence to: Dr Brennan. paul{at}fs1.er.man.ac.uk.

Abstract

Objective: To produce a practical algorithm to predict which patients with early rheumatoid arthritis will develop radiological erosions.
Design: Primary care based prospective cohort study.
Setting: All general practices in the Norwich Health Authority, Norfolk
Subjects: 175 patients notified to the Norfolk Arthritis Register were visited by a metrologist soon after they had presented to their general practitioners with inflammatory polyarthritis, and again after a further 12 months. All the patients satisfied the American Rheumatism Association's 1987 criteria for rheumatoid arthritis and were seen by a metrologist within six months of the onset of symptoms. The study population was randomly split into a prediction sample (n = 105) for generating the algorithm and a validation sample (n = 70) for testing it.
Main outcome measures: Predictor variables measured at baseline included rheumatoid factor status, swelling of specific joint areas, duration of morning stiffness, nodules, disability score, age, sex, and disease duration when the patient first presented. The outcome variable was the presence of radiological erosions in the hands or feet, or both, after 12 months.
Results: A simple algorithm based on a combination of three variables--a positive rheumatoid factor test, swelling of at least two large joints, and a disease duration of more than three months--was best able to predict erosions. When the accuracy of this algorithm was tested with the validation sample, the erosion status of 79% of patients was predicted correctly.
Conclusions: A simple algorithm based on three easily measured items of information can predict which patients are at high risk and which are at low risk of developing radiological erosions.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Algorithm to predict radiological erosions in early rheumatoid arthritis

Paul Emery, Andrew Gough, Joe Devlin, and Michael Green
BMJ 1996 313: 1398. [Extract] [Full Text]

This article has been cited by other articles:

• RENESES, S., GONZALEZ-ESCRIBANO, M. F., FERNANDEZ-SUAREZ, A., PESTANA, L., DAVILA, B., WICHMANN, I., GARCIA, A. (2009). The Value of HLA-DRB1 Shared Epitope, -308 Tumor Necrosis Factor-{alpha} Gene Promoter Polymorphism, Rheumatoid Factor, Anti-Citrullinated Peptide Antibodies, and Early Erosions for Predicting Radiological Outcome in Recent-Onset Rheumatoid Arthritis. The Journal of Rheumatology 36: 1143-1149 [Abstract] [Full text]  
• Nishimura, K., Sugiyama, D., Kogata, Y., Tsuji, G., Nakazawa, T., Kawano, S., Saigo, K., Morinobu, A., Koshiba, M., Kuntz, K. M., Kamae, I., Kumagai, S. (2007). Meta-analysis: Diagnostic Accuracy of Anti-Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor for Rheumatoid Arthritis. ANN INTERN MED 146: 797-808 [Abstract] [Full text]  
• Bukhari, M., Lunt, M., Barton, A., Bunn, D., Silman, A., Symmons, D. (2007). Increasing age at symptom onset is associated with worse radiological damage at presentation in patients with early inflammatory polyarthritis. Ann Rheum Dis 66: 389-393 [Abstract] [Full text]  
• Combe, B, Landewe, R, Lukas, C, Bolosiu, H D, Breedveld, F, Dougados, M, Emery, P, Ferraccioli, G, Hazes, J M W, Klareskog, L, Machold, K, Martin-Mola, E, Nielsen, H, Silman, A, Smolen, J, Yazici, H (2007). EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66: 34-45 [Abstract] [Full text]  
• Goldbach-Mansky, R, Suson, S, Wesley, R, Hack, C E, El-Gabalawy, H S, Tak, P P (2005). Raised granzyme B levels are associated with erosions in patients with early rheumatoid factor positive rheumatoid arthritis. Ann Rheum Dis 64: 715-721 [Abstract] [Full text]  
• Nell, V. P. K., Machold, K. P., Eberl, G., Stamm, T. A., Uffmann, M., Smolen, J. S. (2004). Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 43: 906-914 [Abstract] [Full text]  
• Smolen, J S, Aletaha, D (2004). Patients with rheumatoid arthritis in clinical care. Ann Rheum Dis 63: 221-225 [Full text]  
• Lee, D M, Schur, P H (2003). Clinical utility of the anti-CCP assay in patients with rheumatic diseases. Ann Rheum Dis 62: 870-874 [Abstract] [Full text]  
• Ory, P A (2003). Interpreting radiographic data in rheumatoid arthritis. Ann Rheum Dis 62: 597-604 [Abstract] [Full text]  
• Emery, P, Breedveld, F C, Dougados, M, Kalden, J R, Schiff, M H, Smolen, J S (2002). Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis 61: 290-297 [Abstract] [Full text]  
• Jansen, L M A, van der Horst-Bruinsma, I E, van Schaardenburg, D, Bezemer, P D, Dijkmans, B A C (2001). Predictors of radiographic joint damage in patients with early rheumatoid arthritis. Ann Rheum Dis 60: 924-927 [Abstract] [Full text]  
• Harrison, B., Symmons, D. (2000). Early inflammatory polyarthritis: results from the Norfolk Arthritis Register with a review of the literature. II. Outcome at three years. Rheumatology (Oxford) 39: 939-949 [Full text]  
• Cranney, A., Goldstein, R., Pham, B., Newkirk, M. M, Karsh, J. (1999). A measure of limited joint motion and deformity correlates with HLA-DRB1 and DQB1 alleles in patients with rheumatoid arthritis. Ann Rheum Dis 58: 703-708 [Abstract] [Full text]  
• Emery, P., Gough, A., Devlin, J., Green, M. (1996). Algorithm to predict radiological erosions in early rheumatoid arthritis. BMJ 313: 1398-1398 [Full text]