At EULAR 2025, researchers introduced a clinical tool to help physicians identify patients with joint pain who are more likely to develop rheumatoid arthritis (RA) within 1 year.
The research team, supported by the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR), analyzed data from 2,293 patients across Europe with arthralgia. Of these, 389 developed inflammatory arthritis within 12 months. Researchers compared characteristics between individuals whose condition progressed and those whose did not.
The tool uses six variables—three clinical and three serological—to estimate individual risk and support earlier intervention. The final stratification criteria included morning stiffness, self-reported joint swelling, and difficulty forming a fist. Serologic markers included elevated C-reactive protein (CRP), rheumatoid factor (RF), and anti-citrullinated peptide antibodies (ACPA). These variables were significantly associated with progression to RA.
The team also assessed the value of imaging. Adding ultrasound did not enhance prediction accuracy. Magnetic resonance imaging (MRI), when focused on detecting tenosynovitis, improved model precision. However, MRI is considered optional, as the criteria perform well without imaging in routine clinical settings.
The tool aims to improve consistency in assessing RA risk among patients with symptoms who do not yet meet diagnostic thresholds. It also helps identify candidates for prevention trials, where early immune activity could be targeted before permanent joint damage occurs.
Designed for clinical use, the model provides a standardized and validated approach to estimate risk and guide physician decision-making. Identifying high-risk individuals earlier could facilitate timely treatment and potentially delay or prevent RA onset.
Development involved collaboration among rheumatologists, statisticians, health care professionals, and patient research partners. The model balances simplicity and predictive power, allowing use in both research and practice.
RA affects an estimated 18 million people worldwide. While diagnosis usually follows the onset of symptoms, evidence shows that autoimmune processes often begin much earlier. The criteria address this gap by detecting risk during the preclinical stage.
Although the tool is ready for use, researchers noted the need for further study how patients respond to learning their risk status, which may help clinicians deliver information in ways that support shared decision-making.
The research was presented at EULAR 2025 in Kilchberg, Switzerland, and reflects continued efforts to support RA prevention strategies in clinical care.
Source: EULAR
