EULAR/American College of Rheumatology Risk Stratification Criteria for Development of Rheumatoid Arthritis in the Risk Stage of Arthralgia

van Steenbergen HW, Doornkamp F, Alivernini S, Backlund J, Codreanu C, Cohen SB, Combe B, Cope AP, Deane KD, England BR, Falahee M, de Jong PH, Kleyer A, Lacaille D, Maat B, Mankia K, van Mulligen E, Nagy G, O'Neil LJ, Rodamaker L, Sahbudin I, van Schaardenburg D, Sepriano A, da Silva JA, De Smet L, Sparks JA, Steyerberg EW, Studenic P, Wethington E, Landewé RL, Raza K, van der Helm-van Mil AH (2025)

Publication Type: Journal article

Publication year: 2025

Journal

DOI: 10.1002/art.43218

Abstract

Objective: The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA. Methods: A joint EULAR/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed. Results: Using data from 2,293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% confidence interval [CI] 0.77–0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI 0.82–0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI 0.90–0.97). Conclusions: EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. The criteria can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.

Involved external institutions

Leiden University Medical Center Netherlands (NL) Brigham and Women's Hospital (BWH) United States (USA) (US) Medizinische Universität Wien Austria (AT) National Jewish Health United States (USA) (US) Fondazione Policlinico Universitario Agostino Gemelli IRCCS Italy (IT) University of Amsterdam Netherlands (NL) University of Birmingham United Kingdom (GB) Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) Romania (RO) University of Texas Southwestern Medical Center (UT Southwestern) United States (USA) (US) University of Montpellier / Université Montpellier France (FR) King’s College London United Kingdom (GB) University of Colorado Anschutz Medical Campus United States (USA) (US) University of Nebraska Medical Center (UNMC) United States (USA) (US) Erasmus University Medical Center (MC) Netherlands (NL) University of Leeds United Kingdom (GB) Semmelweis University / Semmelweis Egyetem Hungary (HU) University of Manitoba Canada (CA) Amsterdam Rheumatology & immunology Center (ARC) Netherlands (NL) Centro Hospitalar e Universitário de Coimbra (CHUC) Portugal (PT) Charité - Universitätsmedizin Berlin Germany (DE) University of British Columbia Canada (CA)

How to cite

APA:

van Steenbergen, H.W., Doornkamp, F., Alivernini, S., Backlund, J., Codreanu, C., Cohen, S.B.,... van der Helm-van Mil, A.H. (2025). EULAR/American College of Rheumatology Risk Stratification Criteria for Development of Rheumatoid Arthritis in the Risk Stage of Arthralgia. Arthritis and Rheumatology. https://doi.org/10.1002/art.43218

MLA:

van Steenbergen, Hanna W., et al. "EULAR/American College of Rheumatology Risk Stratification Criteria for Development of Rheumatoid Arthritis in the Risk Stage of Arthralgia." Arthritis and Rheumatology (2025).

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