Four Clinical Variables Predict RA Development in Arthralgia

TOPLINE:

In individuals with seropositive arthralgia, the risk of developing rheumatoid arthritis (RA) rose in the presence of high titers of anti–citrullinated peptide antibodies (ACPAs) and immunoglobulin M-rheumatoid factor (IgM-RF), along with baseline factors, such as first-degree relative status, intermittent symptoms, and morning stiffness.

METHODOLOGY:

• Researchers conducted a 5-year follow-up study to identify the risk factors for the development of RA in at-risk individuals.
• They recruited 617 individuals with seropositive arthralgia (mean age, 49.7 years; 74.4% women) between 2004 and 2019 from rheumatology outpatient clinics in Amsterdam, the Netherlands. Participants tested positive for ACPA (30.8%), IgM-RF (38.8%), or both (30.4%).
• Participants underwent evaluations, including physical examinations, blood tests, and collection of data on symptoms and risk factors, at 6 and 12 months in the first year, followed by annual assessments for up to 5 years.
• Baseline factors for the prediction of RA development were identified.

TAKEAWAY:

• Overall, 33.7% of individuals developed arthritis, with an average time until arthritis of 19.6 months. Among them, 83.7% met the classification criteria for RA.
• Being first-degree relatives of patients with RA (hazard ratio [HR], 1.50), having intermittent symptoms (HR, 1.64) or morning stiffness for at least 1 hour (HR, 1.63), and having swollen joints (HR, 1.51) were significantly associated with an increased risk for developing RA.
• Additionally, having high titers of ACPAs alone increased the risk of developing RA by 4.65 times, whereas being positive for both ACPA and IgM-RF increased the risk by 6.8 times.
• The absolute risk of developing RA reached 67.6% when at least four predictive variables were present at baseline.

IN PRACTICE:

“In summary, our analysis identified four robust variables easily assessed in the clinic that are significantly associated with RA development. The identification of predictors for RA development can aid clinicians and scientists in the selection of those individuals who would benefit the most from preventive strategies, as well as those who might require additional testing and follow-up,” the authors wrote.

SOURCE:

This study was led by Giulia Frazzei, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. It was published online on February 15, 2025, in Annals of the Rheumatic Diseases.

LIMITATIONS:

The researchers noted that because the “cohort only included seropositive participants, it was not possible to evaluate the risk of arthritis in ACPA-positive and/or IgM-RF−positive subjects compared with those presenting with seronegative arthralgia.”

DISCLOSURES:

This study was supported by a grant from the Dutch Arthritis Association and the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant. Two authors reported receiving institutional grants and fees from several pharmaceutical organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.