Background/Purpose:

Early recognition of rheumatoid arthritis (RA) is believed to be the key to successful treatment of this disease. Symptoms of arthralgia often predate development of RA. A set of clinical features assisting recognition of patients during their transition from arthralgia to RA, has been recently proposed. We therefore designed a study, in which we followed patients with unexplained arthralgia prospectively aiming to find new cases of RA and to explore a combination of clinical features and serological markers predicting transition from arthralgia to RA. The aim of the present study was to improve recognition of imminent RA among patients with arthralgia (ALG) using a combination of clinical symptoms with RA-specific antibodies RF and anti-CCP and survivin, serological markers predating transition from ALG to RA.

Methods:

All new cases of RA, undifferentiated arthritis (UA) and unexplained ALG were identified among the total of 1743 first-visit patients attending the rheumatology ward in Gothenburg during 12 consecutive months. The ALG patients were prospectively followed for 48 months and development of additional RA cases was recorded. The set of 13 joint symptoms was applied to the first-visit records aiming to distinguish patients with arthritis from ALG and from the new RA cases. The symptoms with odds ratio >2.0 between ALG and pre-RA and information about RF/aCCP and survivin dichotomised were included in predictive models. Receiver operating characteristic (ROC) curves and Kaplan-Meyers curves were constructed.

Results:

Among the first-visit patients, 63 were classified as RA, 73 had undifferentiated arthritis and 180 had ALG. Additional 32 new RA cases developed during 48 months of follow-up and comprised pre-RA group. The analysis of joint symptoms at the first visit distinguished ALG from RA/UA (both, p<0.001). A combination of symptoms in several small joint areas, increasing number of joints with symptoms, and patient’s experience of swelling in small hand joints at the first visit discriminated pre-RA from ALG with 93% sensitivity (p=0.005, AUC=0.660). Presence of survivin in serum strongly associated with 7 of 13, and RF/aCCP with 1 of 13 joint symptoms. Grouping those symptoms with age>50y, gender, survivin and RF/aCCP in the final algorithm allowed reaching 50% sensitivity for transition from ALG to RA (AUC=0.767, p>0.001).

Conclusion:

Clinical and serological parameters in combination aid recognition of imminent RA among ALG patients with appropriate sensitivity.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/survivin-measurements-improve-prediction-of-rheumatoid-arthritis-among-patients-with-unexplained-arthralgia/