3. MRI bone oedema is the strongest predictor of subsequent radiographic progression in early rheumatoid arthritis. In general it has great human and economics costs. Smolen JS, Landewé R, Breedveld FC, et al. The 2015 ACR Guideline for the treatment of rheumatoid arthritis are also only based on patients` disease activity level without including additional poor prognostic markers. Would you like email updates of new search results? 2005;44:157–63. Joint damage is by far the most often used outcome parameter. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. -, Wu J, Li W, Shi X, Chen Z, Jiang B, Liu J, et al. Stahl EA, Raychaudhuri S. Rheumatoid arthritis. Cookies policy. Hormones (Athens). -, Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. In the careRA trial, the lack of poor prognostic factors was defined as inclusion criteria (Table 2). J Rheumatol. J Korean Med Sci. Patients are then categorized based on presence or absence of one or more of the following poor prognostic features: functional limitation (e.g., HAQ score or similar valid tools); extra-articular disease (e.g., presence of rheumatoid nodules, RA vasculitis, Felty’s syndrome); RF or ACPA antibodies; bony erosions on radiographs. Dementia and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review and meta-analysis. A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Methods. Ann Rheum Dis. Time-integrated DAS28-ESR values during the first year post baseline were assessed by Koga et al. Arthritis Research & Therapy Other factors include functional disability, extraarticular disease, imaging markers, and novel multibiomarkers. The association of increased MBDA scores with radiologic progression was also found in one-year data from the Leiden early arthritis cohort [22]. These findings suggest that SAT accumulation type of obesity is a poor prognostic factor in alcoholic LC patients without HCC, and the hemorrhagic tendency might worsen the poor prognosis in such cases. As the inflammatory markers ESR and CRP are not specific to RA, they cannot be expected to be highly predictive. J Rheumatol. See this image and copyright information in PMC. In conclusion, we found that diabetes mellitus, body temperature ≥ 37.8°C, peripheral oxygen saturation < 92%, and CK-MB > 6.3 are independent predictors of severe disease in hospitalized COVID-19 patients. “Typical RA erosions” are also used for definition [10, 11]. Castrejón I, Dougados M, Combe B, et al. Prognostic factors are used for treatment decisions in rheumatoid arthritis (RA). Bone edema in MRI was predictive for radiologic progression in randomized controlled trial (RCT) and cohort studies [26–28]. Epub 2013 Jun 25. Spread of AML to the brain and spinal cord (called the central nervous system, or CNS) is a poor prognostic factor. Appropriate assessment of prognostic factors and close monitoring to provide the necess … German Rheumatism Research Centre, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany, Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany, You can also search for this author in The relevance of poor prognostic factors for the outcome of RA remains challenging as treatment strategies always interfere as confounders. American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. There is a specific lack of information on the prevalence of single or combined prognostic markers and their relevance. Multibiomarkers, imaging markers, and patient-reported outcomes are currently under investigation and it will be challenging to combine these factors into one predictive model. This site needs JavaScript to work properly. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. PubMed Extraarticular disease appears as a poor prognostic feature in the ACR recommendations only. 2013;40:1268–74. Aggarwal A, Shrivastava A, Kumar A, Ali A. J Assoc Physicians India. 2020 2012;41:15–9. 2020 Nov 19;93:104299. doi: 10.1016/j.archger.2020.104299. Genetic predisposition of the severity of joint destruction in rheumatoid arthritis: a population-based study. The most frequently reported predictors of diagnosis and prognosis of covid-19 are age, body temperature, lymphocyte count, and lung imaging features. 2020 Oct 13. doi: 10.1016/j.jaim.2020.10.006. CAS Gremese E, Salaffi F, Bosello SL, et al. J Rheumatol. 2020 May;222(5):415-426. doi: 10.1016/j.ajog.2020.02.017. Prognostic factors are used for RA diagnosis, treatment decisions, and prognosis of disease severity. The first double-blind, randomised, parallel-group certolizumab pegol study in methotrexate-naive early rheumatoid arthritis patients with poor prognostic factors, C-OPERA, shows inhibition of radiographic progression. J Allergy Clin Immunol. Westhovens R, Robles M, Ximenes AC, et al. | Consistently, three factors are considered to be of relevance for the prognosis of RA. PLoS One. Centola M, Cavet G, Shen Y, et al. Very early rheumatoid arthritis as a predictor of remission: a multicentre real life prospective study. Lee JY, Kim HA, Huh K, Hyun M, Rhee JY, Jang S, Kim JY, Peck KR, Chang HH. Sometimes it is also defined on a qualitative measure as the (new) presence of erosions (yes/no). Therefore, novel mechanistic biomarkers that are directly involved in the disease pathogenesis are being increasingly investigated [19]. Kim K, Choi JW, Moon J, Akilov H, Tuychiev L, Rakhimov B, Min KS. Prognostic factors that have been associated with increased risk of severe disease and mortality include: Izcovich A, Ragusa MA, Tortosa F, et al. Besides autoantibody positivity and erosions, functional limitation and extraarticular disease are also considered as poor prognostic features [4]. Validation of the methotrexate-first strategy in patients with early, poor-prognosis rheumatoid arthritis: results from a two-year randomized, double-blind trial. The primary outcome in these RCTs is remission with different cut-offs and timepoints and secondary outcomes include non-progression or joint damage. The importance of single or combined presence is not assessed. Future research questions should focus on the following points: The definition of poor prognostic markers depends on the targeted outcome, the methods of measurement, and the cut-off values. But several aspects regarding prognostic factors vary. These prediction models are matrix models and all consist of at least two matrices to consider the different treatment strategies in the original trials they are derived from. In a risk model from the SWEFOT cohort, current smoking was reported to be a strong independent predictor of radiographic progression [15]. Those that predict for worse outcomes are called 'poor' prognostic factors. Granger B, Combe B, Le Loet X, Saraux A, Guillemin F, Fautrel B. The clinical outcome was rather related to a fast treatment response than to initial prognosis. Rheumatology (Oxford). Perspectives on future research are also outlined. Performance of matrix-based risk models for rapid radiographic progression in a cohort of patients with established rheumatoid arthritis. Several studies indicated the ability of power Doppler ultrasound to predict disease activity and structural damage [24, 25]. Ann Rheum Dis. 2020 Jul;68(7):19-26. To characterize patients with rheumatoid arthritis (RA) by number of poor prognostic factors (PPF: functional limitation, extraarticular disease, seropositivity, erosions) and evaluate treatment acceleration, clinical outcomes, and work status over 12 months by number of PPF. When to initiate treatment with disease-modifying antirheumatic drugs (DMARDs) in very early RA, treatment intensity, including switching of therapies, and individual treatment response are three domains where prognostic factors are of relevance [1]. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. doi: 10.1136/bmjopen-2020-043651. 2016;43:1974–83. 2016;75:75–83. In addition, both are considered differently in patients with early or established RA (Table 3). Hambardzumyan K, Bolce RJ, Saevarsdottir S, et al. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Arthritis Res Ther. Naredo E, Collado P, Cruz A, et al. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Arthritis Rheum. Arthritis Res Ther 19, 68 (2017). To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis (PTE) following open globe injury. Atsumi T, Yamamoto K, Takeuchi T, et al. 2013;8:e60635. They are discussed in detail in a review by van der Helm-van Mil [1]. Autoantibody positivity can be defined as either RF-positive, ACPA-positive, one of the two, both of them, or a high autoantibody titer. This review summarizes the current definitions of poor prognostic factors and their use in clinical research. Importantly, DKA at onset has been demonstrated to be a poor prognostic factor in type 1 diabetes, not only short-term but also long-term (2), which highlights the importance of efforts at preventing this acute diabetes complication. Clin Exp Rheumatol. PLoS One. The presence of erosions at baseline has been reported by qualitative measure (yes/no) [7] or by the evaluation of radiographs using the Sharp score [9]. A population-based cohort study was conducted based on the Surveillance, Epidemiology, and End Results program. The authors declare that they have no competing interests. 2020;382(18):1708–1720. Various risk matrices have been developed to identify patients at risk for rapid radiologic progression [7, 9, 15, 32]. Poor prognosis was, firstly, defined as the presence of at least three out of four poor prognostic factors: DAS ≥3.7, SJC ≥10, erosions ≥4, and both RF- and ACPA-positive. Although the treatment recommendations are very consistent in suggesting bDMARD therapy in patients with poor prognostic factors at the time of the first DMARD failure, poor prognostic factors are used as inclusion criteria in RCTs for early treatment with bDMARDs in patients with csDMARD-naive RA [6, 31, 40, 41]. Diabetes mellitus (odds ratio [OR], 19.15; 95% confidence interval [CI], 1.90-193.42; P = 0.012), body temperature ≥ 37.8°C (OR, 10.91; 95% CI, 1.35-88.36; P = 0.025), peripheral oxygen saturation < 92% (OR, 33.31; 95% CI, 2.45-452.22; P = 0.008), and creatine kinase-MB (CK-MB) > 6.3 (OR, 56.84; 95% CI, 2.64-1,223.78, P = 0.010) at admission were associated with higher risk of severe COVID-19. 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