Investigating patient related outcomes as tools for predicting disease in individuals at risk for developing arthritis

People with rheumatoid arthritis (RA) should receive targeted DMARD treatment as early as possible. How to manage people at potential risk to develop RA is less clear.

The at‐risk project explores characteristics of individuals at‐risk to develop RA to improve risk stratification and provide the earliest clinical care possible.

We aimed to assess the symptom burden by patient‐reported outcomes in individuals at‐risk included into this program at the Karolinska Institutet. These individuals were ACPA positive with musculoskeletal complaints without signs of clinical or subclinical arthritis at inclusion. These were match to incident early RA patients from the Stockholm region registered in the Swedish Rheumatology Quality register.

• Individuals at risk for RA report less symptom burden than early diagnosed RA patients.
• However, these differences only range around minimal clinically important differences
• No differences at inclusion between progressors towards arthritis and non‐progressors, but progressors worsen and non‐progressors partwise improve over time.

These data stress the need for medical attention and incorporation of PROs in assessment and risk stratification of at‐risk individuals.

Rheumatoid arthritis (RA) is a rheumatic chronic inflammatory disease that impacts function, health-related quality of life (HrQoL) and work participation. It is needed to offer treatment for RA as early as possible to restore HrQoL. This research aimed at understanding how and which symptoms individuals perceive before a potential onset of RA. Certain blood markers, like antibodies in combination with discomfort and problems with joints and muscles (musculoskeletal symptoms) indicate a higher risk to develop RA in the future. The burden of symptoms of individuals at-risk was unclear and how this would compare to patients, that have just been diagnosed with RA. Several patient-reported outcomes exist, that help measuring these symptoms. We used data of a structured at-risk for RA program in Stockholm and routine data of patients with RA, that have been in care in the Stockholm region between 2015 and 2020. We found that symptom burden of patients with RA at time of diagnosis is higher than for at-risk individuals at inclusion in this program. The difference in the measured scores is however smaller than expected in between RA patients and at-risk individuals and ranges around a limit that we know from different studies is around the threshold for detecting a difference between two measurements that might not just be erratic. Symptoms are similar between those that further-on develop arthritis and those that don’t. However, people that don’t develop arthritis improve in pain, fatigue and the global estimation of health, but those developing arthritis get worse over time. This means that at-risk individuals are in need for medical attention and that monitoring of patient-reported outcomes over time helps in better characterising the risk of an individual to develop RA.

• Studenic P, Karlfeldt S, Alunno A. The past, present and future of e-health in Rheumatology. Joint Bone Spine. 2021 Jul;88(4): 105163. DOI: 10.1016/j.jbspin.2021.105163. Epub 2021 Feb 19. PMID: 33618001.
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• Studenic, P, and Radner, H. “Back to Basics: Prioritizing Communication as a Key Instrument in Managing Rheumatoid Arthritis.” Journal of rheumatology 49.2 (2022): 123–125. DOI: 10.3899/jrheum.210984.
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• Van Hoovels, Studenic, P., Sieghart, D., Steiner, G., Bossuyt, X., & Rönnelid, J. (2022). Impact of autoimmune serology test results on RA classification and diagnosis. Journal of Translational Autoimmunity (Online), 5, 100142–100142. https://doi.org/10.1016/j.jtauto.2022.100142
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•  Studenic P, Hensvold A, Kleyer A, van der Helm-van Mil A, Pratt AG, Sieghart D, Krönke G, Williams R, de Souza S, Karlfeldt S, Johannesson M, Krogh NS, Klareskog L and Catrina AI (2022) Prospective Studies on the Risk of Rheumatoid Arthritis: The European Risk RA Registry. Front. Med. 9:824501. doi: 10.3389/fmed.2022.824501
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Abstracts

• Symptoms characteristics of seropositive individuals at‐risk for developing rheumatoid arthritis are versatile and comparable to those in people with early rheumatoid arthritis. P. Studenic, A. Circiumaru, D. Aletaha, K. Chatzidionysiou, A. Hensvold, A. Catrina. DOI: 10.1136/annrheumdis-2021-eular.3884
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• Studenic P, Circiumaru A, Aletaha D, Chatzidionysiou K, Catrina A, Haj Hensvold A. Symptom Burden in Anti-citrullinated Protein Antibody Positive Individuals At-risk for Rheumatoid Arthritis Is Changing over Time and Comparable to Patients with Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10).
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EULAR Poster

2021: POS1441: Symptoms characteristics of seropositive individuals at-risk for developing rheumatoid arthritis are versatile and comparable to those in people with early rheumatoid arthritis. P. Studenic, A. Circiumaru, D. Aletaha, K. Chatzidionysiou, A. Hensvold, A. Catrina