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  • Review Article
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Risk estimation in rheumatoid arthritis—from bench to bedside

Nature Reviews Rheumatology volume 10, pages 171–180 (2014)Cite this article

Subjects

Key Points

  • Currently, treatment decisions in rheumatoid arthritis at disease onset are not individualized, which can result in undertreatment and overtreatment

  • A model predicting the progression from undifferentiated arthritis to rheumatoid arthritis has a reasonable predictive accuracy and is widely validated

  • Presently, available models predicting rapid radiographic progression are not externally validated or do not have insufficient predictive accuracy

  • New performance measures have recently been developed and should be used to assess the performance of risk models in the future

Abstract

The prognosis for patients with rheumatoid arthritis (RA) who were diagnosed in the years since 2010 is much better than for individuals who were diagnosed with the disease 20 years ago. This improvement in the long-term outcome of disease is the result of earlier initiation of therapy, disease-activity-guided modification of treatment and the availability of new, and effective, drugs. Nonetheless, current treatment strategies remain population-based, rather than individualized. Decision-making processes relevant to the provision of individualized treatment require appropriate prognostication with regard to a number of variables. Here, the methods available to evaluate the performance of predictive models are discussed. In addition, I highlight the advances in risk estimation that have been made concerning three treatment decisions relevant to the management of RA that are made daily in the clinic: when to initiate treatment with DMARDs in patients in the early stages of arthritis; the ideal intensity of initial treatment; and the likely responsiveness of the patient to a particular therapy. Apart from a model predicting the development of RA, the majority of prognostic tools derived in arthritis and RA are not accurate or not validated. Hence, personalized treatment decisions in arthritis and RA are still far from bedside.

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Figure 1: Course of inflammation relating to the development of RA.

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Authors and Affiliations

  1. Department of Rheumatology, Leiden University Medical Centre, P. O. Box 9600, Leiden, 2300 RC, Netherlands

    Annette H. M. van der Helm-van Mil

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  1. Annette H. M. van der Helm-van Mil
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Correspondence to Annette H. M. van der Helm-van Mil.

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The author declares no competing financial interests.

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van der Helm-van Mil, A. Risk estimation in rheumatoid arthritis—from bench to bedside. Nat Rev Rheumatol 10, 171–180 (2014). https://doi.org/10.1038/nrrheum.2013.215

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