title: EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis.
abstract: BACKGROUND
  During the transition to rheumatoid arthritis (RA) many patients pass through a phase characterised by the presence of symptoms without clinically apparent synovitis. These symptoms are not well-characterised. This taskforce aimed to define the clinical characteristics of patients with arthralgia who are considered at risk for RA by experts based on their clinical experience.
  
  
  METHODS
  The taskforce consisted of 18 rheumatologists, 1 methodologist, 2 patients, 3 health professionals and 1 research fellow. The process had three phases. In phase I, a list of parameters considered characteristic for clinically suspect arthralgia (CSA) was derived; the most important parameters were selected by a three-phased Delphi approach. In phase II, the experts evaluated 50 existing patients on paper, classified them as CSA/no-CSA and indicated their level of confidence. A provisional set of parameters was derived. This was studied for validation in phase III, where all rheumatologists collected patients with and without CSA from their outpatient clinics.
  
  
  RESULTS
  The comprehensive list consisted of 55 parameters, of which 16 were considered most important. A multivariable model based on the data from phase II identified seven relevant parameters: symptom duration <1 year, symptoms of metacarpophalangeal (MCP) joints, morning stiffness duration ≥60 min, most severe symptoms in early morning, first-degree relative with RA, difficulty with making a fist and positive squeeze test of MCP joints. In phase III, the combination of these parameters was accurate in identifying patients with arthralgia who were considered at risk of developing RA (area under the receiver operating characteristic curve 0.92, 95% CI 0.87 to 0.96). Test characteristics for different cut-off points were determined.
  
  
  CONCLUSIONS
  A set of clinical characteristics for patients with arthralgia who are at risk of progression to RA was established.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hanna W
authors.initials: HW
authors.lastname: van Steenbergen
authors.affiliation: Department of Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Liesbeth J J
authors.initials: LJ
authors.lastname: Beaart-van de Voorde
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center, Groningen, The Netherlands.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brouwer
authors.affiliation: Rheumatology Department, Center of Rheumatic Diseases, Bucharest, Romania.
authors.forename: Catalin
authors.initials: C
authors.lastname: Codreanu
authors.affiliation: Department of Rheumatology, Montpellier University Hospital, Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.|Rheumatology Department, Centro Hospitalar de Lisboa Norte, EPE, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon, Portugal.
authors.forename: João E
authors.initials: JE
authors.lastname: Fonseca
authors.affiliation: DANBIO registry and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Merete L
authors.initials: ML
authors.lastname: Hetland
authors.affiliation: Queen Mary University of London, Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, London, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Humby
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Niedermann
authors.affiliation: Department of Rheumatology, Hospital Universitario La Paz-IdiPaz, Paseo de La Castellana, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Nuño
authors.affiliation: Independent Nurse Consultant, North Devon, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Oliver
authors.affiliation: Department of Public Health and Clinical Medicine/Rheumatology, University Hospital, Umeå, Sweden.
authors.forename: Solbritt
authors.initials: S
authors.lastname: Rantapää-Dahlqvist
authors.affiliation: Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.|Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Karim
authors.initials: K
authors.lastname: Raza
authors.affiliation: Amsterdam Rheumatology and immunology Center, locations Reade and Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Dirkjan
authors.initials: D
authors.lastname: van Schaardenburg
authors.affiliation: Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: De Smet
authors.affiliation: Department of Rheumatology, University of Debrecen Medical Center, Debrecen, Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Szücs
authors.affiliation: Department of Rheumatology, First Faculty of Medicine, Institute of Rheumatology, Charles University, Prague, Czech Republic.
authors.forename: Jirí
authors.initials: J
authors.lastname: Vencovský
authors.affiliation: Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wiland
authors.affiliation: EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland.
authors.forename: Maarten
authors.initials: M
authors.lastname: de Wit
authors.affiliation: Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands and Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Landewé
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.|Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Annette H M
authors.initials: AH
authors.lastname: van der Helm-van Mil
mesh_terms: D018771:Arthralgia / Q000209:etiology / Q000503:physiopathology*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology*; D002940:Circadian Rhythm; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000503:physiopathology*; D016059:Range of Motion, Articular; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors
keywords: Early Rheumatoid Arthritis; Outcomes research; Rheumatoid Arthritis