Prediction of Disease Outcome in Early Arthritis

Abstract

The terms early arthritis, undifferentiated arthritis (UA) and early rheumatoid arthritis (RA) are not completely synonymous. They refer to slightly different sets of patients with intrinsic differences in the disease outcome. UA refers to arthritis that cannot be classified according to current criteria. The disease course of UA is variable, 40–50% remit spontaneously, whereas about one third of the UA-patients are in an early phase of RA. These UA-patients provide an opportunity, as the disease process in UA is less established and treatment in this early phase may halt the progression towards RA. To identify the UA-patients who will develop RA a prediction rule has recently been developed. This rule estimates the chance to develop RA in individual UA-patients and its predictive ability is established in several countries throughout the world. Another initiative to identify RA patients early is the development of new classification criteria for RA. The sensitivity and specificity for early RA of these criteria are not known yet. Clinical trials evaluating the effects of DMARD-therapy in UA are still scarce but are needed in order to derive a personalized medicine for UA-patients.

Zusammenfassung

Die Begriffe Früharthritis, undifferenzierte Arthritis (UA) und frühe rheumatoide Arthritis (RA) sind nicht vollständig synonym zu gebrauchen. Vielmehr beschreiben sie verschiedene Patientensubgruppen mit spezifischen Unterschieden des Krankheitsverlaufes. UA bezeichnet eine Arthritis, die gemäß aktueller Kriterien nicht klassifiziert werden kann. Der Krankheitsverlauf ist variabel, 40–50% remittieren spontan, während ein Drittel der UA Patienten sich bereits in einem Frühstadium einer RA befindet. Bei diesen UA Patienten besteht die Chance, durch entsprechende Behandlung in dieser frühen Phase die Progression in Richtung RA aufzuhalten, da der Krankheitsprozess zu diesem Zeitpunkt noch weniger etabliert ist. Um Patienten zu identifizieren, die eine RA entwickeln werden, wurde kürzlich ein Vorhersage Score entwickelt. Dieser Score ermöglicht eine Risikoabschätzung für den individuellen UA Patienten für die Entwicklung einer RA. Der prädiktive Wert dieses Scores ist in zahlreichen Ländern weltweit etabliert. Eine weitere Möglichkeit zur frühen Identifikation von RA Patienten ist die Entwicklung neuer Klassifikationskriterien für die RA. Die Sensitivität und die Spezifität für diese Kriterien sind bisher nicht erforscht. Es liegen nur wenige klinische Studien zur Bewertung der Wirksamkeit der DMARD-Therapie bei UA vor. Solche Untersuchungen werden aber dringend benötigt, um UA Patienten eine spezifische Medikation bieten zu können.

Key words

early arthritis - prognosis - rheumatoid arthritis

Schlüsselwörter

Früharthritis - Prognose - Rheumatoide Arthritis

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