Predicting Inflammatory Arthritis in At-Risk Persons Save
The Annals of Internal Medicine has published a predictive score to distinguish low-risk from high-risk inflammatory arthritis (IA) and who may benefit from risk stratification and preventive measures.
A prospective observational cohort study done in the UK used a cohort of "at-risk" individuals (accumulated over 13 years) with new musculoskeletal symptoms, a positive test result for anticitrullinated protein antibodies (ACPA), and no clinical synovitis and were followed for 48 weeks or more or until IA occurred.
From a total of 455 participants, 32.5% (n=148) developed IA; 15.4% within 1 year.
A simple score (using multidimensional biomarkers).identified 249 low-risk participants with a false negative rate of 5% and 206 high-risk participants with a false-positive rate of 72%).
The comprehensive score identified 119 high-risk participants with a false-positive rate of 29% (and 336 low-risk participants with a false-negative rate of 19%); Ultimately, 40% of high-risk participants developed IA within 1 year and 71% within 5 years.
The simple score was developed using logistic regression and was used to identify persons at low risk for IA . The comprehensive score identified high-risk persons who could benefit from risk stratification and preventive measures.
External validation of these results are required to show consistency and utility.
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Promising. However, it is unfortunate that the system for getting advanced biomarkers into clinical practice is too complex with numerous barriers. For example, almost all the insurance-covered SLE biomarkers are over 55 years old. CCP antibody is the newest covered one for RA, and its report is now 25 years old. The FDA and CMS need to revise their approval processes. Rheumatologists need to work on solutions, otherwise, our patients will continue to have delayed dxs, misdiagnoses, under-tx, high morbidity/mortality, & tx'd in a "trial and error." The ACR needs to do a better job supporting them; Key opinion leaders need to support their use and teach others to use them in daily clinical practice, etc. I hope others will become passionate about this topic, otherwise, biotech companies performing lab translational research will continue to go bankrupt (Immunarray with the SLE-key rule-out test, for example) or lose their patents only to allow Labcorp and Quest to offer the tests 10-20 years after biomarker discoveries (like Dr. Susan Manzi's CB-CAPS will in 2024). Currently, personalized medicine and translational biomarker research look great on paper but is not a reality.
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The author has no conflicts of interest to disclose related to this subject
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