Frequency and predictors of disease progression in contemporary anticitrullinated protein antibodies (ACPA)-negative undifferentiated arthritis in a treated-to-target early arthritis clinic
Authors' conclusion
In contemporary ACPA-negative UA, progression is driven by anatomical joint distribution rather than generic disease activity. Combined hand/large-joint involvement identifies a high-risk phenotype, while CRP refines risk in clinically milder branches.
Study context
- Population
- Consecutive ACPA-negative patients with undifferentiated arthritis (clinical synovitis not fulfilling 1987 or 2010 rheumatoid arthritis (RA) criteria and without alternative diagnosis at baseline or within 6 months) enrolled in the Pavia Early Arthritis Clinic (2011–2019); all started hydroxychloroquine, with escalation driven by persistent disease activitypatients analysed
- Participants
- 402 patients
- Comparison
- Combined hand and large-joint arthritis as a predictor of RA development and of the composite of RA development or treatment intensification
- Outcome
- RA development
- Follow-up
- 24 months
Methodological detailsstandardised treat-to-target protocol, classification tree analysis
- Standardised treat-to-target protocol
- Classification tree analysis
Main finding
As reported in the abstract
Patients who developed RA
13.1%
Further findings
RA development, by combined hand and large-joint arthritis · 24 months
| Adjusted OR (95% CI) | ||
|---|---|---|
| COMBINED HAND/LARGE-JOINTIndependent predictor; comparator not stated | 2.68 (1.29–5.57) | |
| 0.20.5125Adjusted odds ratio (log scale) |
Composite outcome, by combined hand and large-joint arthritis · 24 months
| Adjusted OR (95% CI) | ||
|---|---|---|
| COMBINED HAND/LARGE-JOINTIndependent predictor; comparator not stated | 3.32 (1.77–6.24) | |
| 0.10.31310Adjusted odds ratio (log scale) |
RA development or treatment intensification (composite) · 24 months
- Patients who developed RA or required treatment intensification
- 38.1%
Treatment intensification
- C reactive protein (CRP) elevation and pain burden were associated with treatment intensification
Classification tree analysis (large-joint involvement first discriminator; with the no-large-joint/CRP >0.5 mg/dL branch)
- Events captured
- 64%
- Positive predictive value
- 48%
- Negative predictive value
- 72%
Original publication
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