EULAR/ACR risk stratification criteria for development of rheumatoid arthritis in the risk stage of arthralgia
Abstract
Objectives: The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA. Methods: A joint European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed. Results: Using data from 2293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% CI, 0.77-0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI, 0.82-0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI, 0.90-0.97). Conclusions: EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. They can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.
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BibTeX
@article{steenbergen2026eularacr,
title = {{EULAR/ACR risk stratification criteria for development of rheumatoid arthritis in the risk stage of arthralgia}},
author = {Hanna van Steenbergen and Frank Doornkamp and Stefano Alivernini and John Backlund and Catalin Codreanu and Stanley Cohen and Bernard Combe and Andrew Cope and Kevin Deane and Bryant England and Marie Falahee and Pascal de Jong and Arnd Kleyer and Diane Lacaille and Bertha Maat and Kulveer Mankia and Elise van Mulligen and György Nagy and Liam O'Neil and Linda Rodamaker and Ilfita Sahbudin and Dirkjan van Schaardenburg and Alexandre Sepriano and Jose da Silva and Lukas de Smet and Jeffrey Sparks and Ewout Steyerberg and Paul Studenic and Elisabeth Wethington and Robert Landewé and Karim Raza and Annette H.M. van der Helm-van Mil},
journal = {Annals of the Rheumatic Diseases},
year = {2026},
month = sep,
doi = {10.1016/j.ard.2025.01.021},
url = {https://hal.science/hal-05735361v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - EULAR/ACR risk stratification criteria for development of rheumatoid arthritis in the risk stage of arthralgia
AU - Hanna van Steenbergen
AU - Frank Doornkamp
AU - Stefano Alivernini
AU - John Backlund
AU - Catalin Codreanu
AU - Stanley Cohen
AU - Bernard Combe
AU - Andrew Cope
AU - Kevin Deane
AU - Bryant England
AU - Marie Falahee
AU - Pascal de Jong
AU - Arnd Kleyer
AU - Diane Lacaille
AU - Bertha Maat
AU - Kulveer Mankia
AU - Elise van Mulligen
AU - György Nagy
AU - Liam O'Neil
AU - Linda Rodamaker
AU - Ilfita Sahbudin
AU - Dirkjan van Schaardenburg
AU - Alexandre Sepriano
AU - Jose da Silva
AU - Lukas de Smet
AU - Jeffrey Sparks
AU - Ewout Steyerberg
AU - Paul Studenic
AU - Elisabeth Wethington
AU - Robert Landewé
AU - Karim Raza
AU - Annette H.M. van der Helm-van Mil
PY - 2026
DA - 2026/09/02
JO - Annals of the Rheumatic Diseases
DO - 10.1016/j.ard.2025.01.021
UR - https://hal.science/hal-05735361v1
AB - Objectives: The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA. Methods: A joint European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed. Results: Using data from 2293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% CI, 0.77-0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI, 0.82-0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI, 0.90-0.97). Conclusions: EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. They can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.
SN - 0003-4967
SN - 1468-2060
ER -