Validation of a prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis
Validation of a prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis
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DOI：
10.1002/art.23681
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发表时间：
2008-08-01
影响因子：
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通讯作者：
Raza, Karim
中科院分区：
文献类型：
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作者：
van der Helm-van Mil, Annette H.;Detert, Jacqueline;Raza, Karim
Objective.在新近发作的未分化关节炎（UA）患者中开始使用疾病缓解抗风湿药物的决定因各种自然病程而复杂化，其中三分之一的患者进展为类风湿性关节炎（RA），而40-50%的患者经历自发缓解。最近，开发了一种预测规则来估计UA患者进展为RA的机会。本研究调查了这一预测规则在UA患者独立队列中的准确性。在来自英国、德国和荷兰的3个近期发作UA患者队列中，计算预测评分和相应的RA发生几率。这些数据与随访≥ 1年后观察到的疾病结局进行比较。阳性预测值（PPV）和阴性预测值（NPVs）。计算并使用受试者工作特征曲线下面积（AUC）评估预测规则的总体区分能力。由于在所有验证队列中均未获得晨僵严重程度的数据，因此以晨僵持续时间作为替代，重新推导了预测规则。该规则的AUC为0.88（SEM 0.015）。对于每个验证队列，英国、德国和荷兰队列的AUC分别为0.83（SEM 0.041）、0.82（SEM 0.037）和0.95（SEM 0.031）。NPV（预测得分
Objective. The decision to start disease-modifying antirheumatic drugs in patients with recent-onset undifferentiated arthritis (UA) is complicated by a varied natural disease course in which the disease in one-third of patients progresses to rheumatoid arthritis (RA), whereas 40-50% of patients experience spontaneous remission. Recently, a prediction rule was developed to estimate the chance of progression to RA in individual patients presenting with UA. This study investigates the accuracy of this prediction rule in independent cohorts of patients with UA.Methods. In 3 cohorts of patients with recent-onset UA, from the UK, Germany, and The Netherlands, the prediction score and the corresponding chance of developing RA were calculated. These data were compared with the observed disease outcome after >= 1 year of followup. Positive predictive values (PPVs) and negative predictive values (NPVs) were. calculated and the overall discriminative ability of the prediction rule was assessed using area under the receiver operating characteristic curves (AUCs).Results. Since data on the severity of morning stiffness were not available in all validation cohorts, the prediction rule was rederived with the duration of morning stiffness as a substitute. The AUC for this rule was 0.88 (SEM 0.015). For each validation cohort, the AUC was 0.83 (SEM 0.041), 0.82 (SEM 0.037), and 0.95 (SEM 0.031) in the British, German, and Dutch cohorts, respectively. The NPV (for a prediction score