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Predictive value of ACR core set parameters for the development of rheumatoid arthritis in patients with positive anti-cyclic citrullinated peptide antibodies and undifferentiated arthritis SIR, The identification of baseline parameters that might predict the evolution of undifferentiated arthritis (UA) into RA is essential to initiate early therapy in patients. UA patients who have ACPAs are at high risk of developing RA. We prospectively recruited 32 ACPA-positive UA patients in order to identify risk factors associated with progression to RA and/or development of bone erosion. The 2010 ACR/European League Against Rheumatism (EULAR) criteria were applied to our cohort. Sixty-eight patients with early RA (ERA) were analysed as a control group. The study was approved by the institutional review board (Commission d'e ´ thique hospitalo-facultaire, Université Catholique de Louvain) and performed according to the Declaration of Helsinki. All patients provided written consent. Baseline characteristics of ERA and UA patients are summarized in Table 1. At baseline, UA patients had a mean of 6.4 (S.D. 4.7) tender joints and a mean of 2.8 (S.D. 1.5) swollen joints. The mean 28-joint DAS (DAS28)-CRP was 3.94 (S.D. 0.85). Hand and feet erosion were observed on the X-rays in three UA patients. After 1 and 2 years of follow-up, 13 (40.6%) and 22 (68.8%) UA patients, respectively, developed RA. Table 1 also shows the distribution of baseline characteristics in UA patients according to the development of RA or not after 2 years of follow-up (UA-RA, n = 22 vs UA-UA, n = 10). Mean tender joint count (TJC), swollen joint count (SJC), physician visual analogue scale (VAS) and serum CRP were lower in UA-UA compared with UA-RA patients, but the differences are not significant. Intriguingly, the MRI erosive pattern was also not different in the two groups at baseline. We attributed cutoff values for the baseline variables that yielded the best sensitivity and specificity for the determination of two outcomes: having a diagnosis of RA after 2 years of follow-up and having X-ray visible erosion after 2 years (serum CRP >0.7 mg/dl, HAQ >1/3, DAS28-CRP >3.53, physician VAS >25 mm and patient VAS >50 mm). No statistical relationship was found between the chosen parameters and the endpoints. For each patient at baseline, the 2010 ACR/EULAR classification criteria score for RA was calculated and compared with the diagnosis after the follow-up period. At baseline, 28 (87.5%) UA patients included had a score 56 or erosion at baseline. …

rheumatology

Predictive value of ACR core set parameters for the development of rheumatoid arthritis in patients with positive anti-cyclic citrullinated peptide antibodies and undifferentiated arthritis