Prediction and prevention of rheumatoid arthritis

a substantial proportion of patients who present with probable rheumatoid arthritis (probable ra or undifferentiated arthritis = ua) progresses to ra. in a randomized trial we demonstrated that in patients with ua methotrexate is an effective drug to inhibit symptoms, structural damage, and progression towards ra. however 4050% of uapatients remit spontaneously. therefore adequate treatment decisionmaking in earlyua necessitates identification of the uapatients that will develop ra. we developed a prediction rule using data from the leiden early arthritis clinic, an inception cohort of patients with recentonset arthritis (n=1700). the patients that presented with ua were selected (n=570); progression to ra or other diagnosis was monitored after oneyear followup. the prediction rule consisted of nine clinical variables: gender, age, localization of symptoms, morning stiffness, tender and swollen joint count, creactive protein, rheumatoid factor and anticcp antibodies. each prediction score varies between 0 and 14 and corresponds to a chance (percentage) ra development. thus, in earlyua the risk to develop ra can be predicted, thereby allowing individualized treatment decisions to initiate diseasemodifying antirheumatic drugs in patients who present with ua.