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Prognostic factors in rheumatoid arthritis in the era of biologic agents

Nature Reviews Rheumatology volume 5, pages 491–496 (2009)Cite this article

Abstract

The management of patients with rheumatoid arthritis (RA) has changed dramatically in recent years, largely because of the unrivaled efficacy of biologic agents in ameliorating clinical disease activity and in preventing joint damage; however, the use of biologic agents is associated with medical risks and socioeconomic costs. Guidance is, therefore, needed to identify those patients who might benefit most from this intensive treatment approach—and to identify those individuals who can be spared the potential adverse effects of such treatment without risking disease progression. As reviewed here, a variety of serological, clinical, immunological, radiological, and genetic markers have been proposed to predict clinical outcome in RA. These markers can all be determined without difficulty; however, with the notable exception of the genetic markers and erosions, these parameters are for the most part indicative of inflammatory disease activity and, therefore, subject to variation. As tight control of disease activity dissociates the prognostic markers from the clinical course, these predictive parameters should be assessed at baseline for every patient and used to guide individualized treatment strategies.

Key Points

  • In rheumatoid arthritis (RA), several prognostic factors have been identified that predict the development of erosive disease in patients with early disease not yet showing bone pathology

  • On the basis of these markers, algorithms have been developed that determine the risk of joint destruction in a given individual

  • Most markers predictive of bone destruction in RA are related to or indicative of inflammatory disease activity and are, therefore, prone to alteration by treatment

  • As inflammatory disease activity can be halted by modern treatment, therapy is an important confounder in identifying predictors for erosive disease

  • Appropriate treatment dissociates the risk factors and the course of the disease

  • Individual risk factors should be assessed or algorithms used at baseline in every patient with early RA to individualize treatment strategies

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Acknowledgements

Supported by the Deutsche Forschungsgemeinschaft, the Sonderforschungsbereich 571 at the Medical Faculty of the University of Munich and the Graduiertenkolleg 1202 at the University of Munich.

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  1. Division of Rheumatology, Medizinische Poliklinik, University of Munich, Munich, Germany

    Alla Skapenko, Iryna Prots & Hendrik Schulze-Koops

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Correspondence to Hendrik Schulze-Koops.

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Skapenko, A., Prots, I. & Schulze-Koops, H. Prognostic factors in rheumatoid arthritis in the era of biologic agents. Nat Rev Rheumatol 5, 491–496 (2009). https://doi.org/10.1038/nrrheum.2009.157

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