In contrast to the risk models, not structural damage but remission was the targeted outcome here. Results from an Italian early arthritis cohort provided evidence that in early RA, less than 12 weeks’ disease duration at the time of first treatment and DMARD initiation within 3 months were the main predictors of DAS28 remission. In any way, smoking as a patient habit is not considered in treatment recommendations. In the ESPOIR cohort, smoking was not predictive of rapid radiologic progression. In a risk model from the SWEFOT cohort, current smoking was reported to be a strong independent predictor of radiographic progression. Smoking is known to be associated with the development of RA and with treatment response but the impact on clinical or radiologic outcomes has not been clarified. They should be kept in mind even though no validation studies have referenced extraarticular disease as a prognostic factor. The importance of extraarticular RA features is that they reflect severe disease, more often seen in past and longstanding disease. Extraarticular diseaseĮxtraarticular disease appears as a poor prognostic feature in the ACR recommendations only. In the American College of Rheumatology (ACR) Recommendations for the use of DMARDs and Biologics in the treatment of RA it is stated that functional limitation could also be reported by similar valid tools. Functional limitationįunctional limitation has rarely been investigated as a poor prognostic marker but has been reported consistently by health assessment questionnaire (HAQ) scores. “Typical RA erosions” are also used for definition. The presence of erosions at baseline has been reported by qualitative measure (yes/no) or by the evaluation of radiographs using the Sharp score. Most commonly, poor prognosis is assessed by RF or ACPA positivity but other definitions are also used (e.g., ACPA three or more times the upper limit of normal or RF >200 U/l, ACPA and RF positivity ). ![]() Īutoantibody positivity can be defined as either RF-positive, ACPA-positive, one of the two, both of them, or a high autoantibody titer. In treatment recommendations, high disease activity is either not further specified or defined by validated composite scores such as the disease activity score based on 28 joints (DAS28 > 5.1). Heterogeneous definitions are also applied for the definition of disease activity as inclusion criteria in randomized controlled trials (Table 2). In risk models, different cut-off values have been used for these parameters to predict patients at risk for rapid radiographic progression (Table 1). Disease activityĭisease activity has been assessed by serum levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as well as the number of tender joints (TJC) and swollen joints (SJC). Other factors that have been investigated include disability at baseline, extraarticular disease, smoking, imaging markers, protein biomarkers, and genetic markers. These factors are acknowledged to be of importance for the course of RA. Factors that are used predominantly for treatment decisions are high disease activity, the early presence of erosions, and autoantibody positivity. So far, there is no uniform definition of poor prognostic factors. ![]() ![]() Prognostic factors are used for RA diagnosis, treatment decisions, and prognosis of disease severity. Full-text papers published until November 2016 were included and references were screened for further relevant papers. Definitions are compared and the use is described.Ī PubMed search was performed to identify the publications in this review with the following search terms used: rheumatoid arthritis, poor prognostic factors, poor prognosis, prediction. This review provides an overview on the use of poor prognostic factors in randomized controlled trials, in cohort studies, and in treatment recommendations. Besides the type of prognostic factors, definitions, measurements, the relevant outcome, and the timepoint of the measured outcome also vary among the existing studies. These features are still under investigation or do not appear uniformly in recommendations and clinical research. Other factors include functional disability, extraarticular disease, imaging markers, and novel multibiomarkers. These are high disease activity, positivity for rheumatoid factor (RF) and/or anti-citrullinated protein-peptide antibodies (ACPA), and the early presence of structural damage. Ĭonsistently, three factors are considered to be of relevance for the prognosis of RA. When to initiate treatment with disease-modifying antirheumatic drugs (DMARDs) in very early RA, treatment intensity, including switching of therapies, and individual treatment response are three domains where prognostic factors are of relevance. Prognostic factors have been established as a clinical tool for treatment decisions in rheumatoid arthritis (RA).
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