EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis

Hanna W van Steenbergen; Daniel Aletaha; Liesbeth J J Beaart-van de Voorde; Elisabeth Brouwer; Catalin Codreanu; Bernard Combe; João E. Fonseca; Merete L Hetland; Frances Humby; Tore K. Kvien; Karin Niedermann; Laura Nuno; Sue Oliver; Solbritt Rantapää-Dahlqvist; Karim Raza; Dirkjan van Schaardenburg; Georg Schett; Liesbeth De Smet; Gabriella Szucs; Jirí Vencovsky; Piotr Wiland; Maarten De Wit; Robert L Landewé; Annette H M van der Helm-van Mil

doi:10.1136/annrheumdis-2016-209846

EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis

Hanna W van Steenbergen, Daniel Aletaha, Liesbeth J J Beaart-van de Voorde, Elisabeth Brouwer, Catalin Codreanu, Bernard Combe, João E. Fonseca, Merete L Hetland, Frances Humby, Tore K. Kvien, Karin Niedermann, Laura Nuno, Sue Oliver, Solbritt Rantapää-Dahlqvist, Karim Raza, Dirkjan van Schaardenburg, Georg Schett, Liesbeth De Smet, Gabriella Szucs, Jirí VencovskyPiotr Wiland, Maarten De Wit, Robert L Landewé, Annette H M van der Helm-van Mil

Institut for Klinisk Medicin

105 Citationer (Scopus)

Abstract

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.

Originalsprog	Engelsk
Tidsskrift	Annals of the Rheumatic Diseases
Vol/bind	76
Udgave nummer	3
Sider (fra-til)	491-496
Antal sider	6
ISSN	0003-4967
DOI	https://doi.org/10.1136/annrheumdis-2016-209846
Status	Udgivet - 1 mar. 2017

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10.1136/annrheumdis-2016-209846

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van Steenbergen, H. W., Aletaha, D., Beaart-van de Voorde, L. J. J., Brouwer, E., Codreanu, C., Combe, B., Fonseca, J. E., Hetland, M. L., Humby, F., Kvien, T. K., Niedermann, K., Nuno, L., Oliver, S., Rantapää-Dahlqvist, S., Raza, K., van Schaardenburg, D., Schett, G., De Smet, L., Szucs, G., ... van der Helm-van Mil, A. H. M. (2017). EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Annals of the Rheumatic Diseases, 76(3), 491-496. https://doi.org/10.1136/annrheumdis-2016-209846

van Steenbergen, HW, Aletaha, D, Beaart-van de Voorde, LJJ, Brouwer, E, Codreanu, C, Combe, B, Fonseca, JE, Hetland, ML, Humby, F, Kvien, TK, Niedermann, K, Nuno, L, Oliver, S, Rantapää-Dahlqvist, S, Raza, K, van Schaardenburg, D, Schett, G, De Smet, L, Szucs, G, Vencovsky, J, Wiland, P, De Wit, M, Landewé, RL & van der Helm-van Mil, AHM 2017, 'EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis', Annals of the Rheumatic Diseases, bind 76, nr. 3, s. 491-496. https://doi.org/10.1136/annrheumdis-2016-209846

@article{f43c7f4009d047c299d3d947a0fbe475,

title = "EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis",

abstract = "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.",

keywords = "Arthralgia, Arthritis, Rheumatoid, Circadian Rhythm, Consensus, Delphi Technique, Humans, Metacarpophalangeal Joint, Range of Motion, Articular, Risk Assessment, Risk Factors, Sensitivity and Specificity, Time Factors, Consensus Development Conference, Journal Article, Multicenter Study, Validation Studies",

author = "{van Steenbergen}, {Hanna W} and Daniel Aletaha and {Beaart-van de Voorde}, {Liesbeth J J} and Elisabeth Brouwer and Catalin Codreanu and Bernard Combe and Fonseca, {Jo{\~a}o E.} and Hetland, {Merete L} and Frances Humby and Kvien, {Tore K.} and Karin Niedermann and Laura Nuno and Sue Oliver and Solbritt Rantap{\"a}{\"a}-Dahlqvist and Karim Raza and {van Schaardenburg}, Dirkjan and Georg Schett and {De Smet}, Liesbeth and Gabriella Szucs and Jir{\'i} Vencovsky and Piotr Wiland and {De Wit}, Maarten and Landew{\'e}, {Robert L} and {van der Helm-van Mil}, {Annette H M}",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.",

year = "2017",

month = mar,

day = "1",

doi = "10.1136/annrheumdis-2016-209846",

language = "English",

volume = "76",

pages = "491--496",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "B M J Group",

number = "3",

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TY - JOUR

T1 - EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis

AU - van Steenbergen, Hanna W

AU - Aletaha, Daniel

AU - Beaart-van de Voorde, Liesbeth J J

AU - Brouwer, Elisabeth

AU - Codreanu, Catalin

AU - Combe, Bernard

AU - Fonseca, João E.

AU - Hetland, Merete L

AU - Humby, Frances

AU - Kvien, Tore K.

AU - Niedermann, Karin

AU - Nuno, Laura

AU - Oliver, Sue

AU - Rantapää-Dahlqvist, Solbritt

AU - Raza, Karim

AU - van Schaardenburg, Dirkjan

AU - Schett, Georg

AU - De Smet, Liesbeth

AU - Szucs, Gabriella

AU - Vencovsky, Jirí

AU - Wiland, Piotr

AU - De Wit, Maarten

AU - Landewé, Robert L

AU - van der Helm-van Mil, Annette H M

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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.

AB - 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.

KW - Arthralgia

KW - Arthritis, Rheumatoid

KW - Circadian Rhythm

KW - Consensus

KW - Delphi Technique

KW - Humans

KW - Metacarpophalangeal Joint

KW - Range of Motion, Articular

KW - Risk Assessment

KW - Risk Factors

KW - Sensitivity and Specificity

KW - Time Factors

KW - Consensus Development Conference

KW - Journal Article

KW - Multicenter Study

KW - Validation Studies

U2 - 10.1136/annrheumdis-2016-209846

DO - 10.1136/annrheumdis-2016-209846

M3 - Journal article

C2 - 27991858

SN - 0003-4967

VL - 76

SP - 491

EP - 496

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 3

ER -

EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis

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