The 1987 ACR classification criteria for rheumatoid arthritis were criticized for their lack of sensitivity in early disease. To overcome this limitation, new criteria have now been developed. The... Show moreThe 1987 ACR classification criteria for rheumatoid arthritis were criticized for their lack of sensitivity in early disease. To overcome this limitation, new criteria have now been developed. The question is how will these criteria be implemented in clinical and basic research, and in daily clinical practice? Show less
Nies, J.A.B. van; Knevel, R.; Daha, N.; Linden, M.P.M. van der; Gregersen, P.K.; Kern, M.; ... ; Helm-van Mil, A.H.M. van der 2010
This thesis investigated the association between several genetic factors and autoantibodies and the development of undifferentiated arthritis (UA) and rheumatoid arthritits (RA). Second, this... Show moreThis thesis investigated the association between several genetic factors and autoantibodies and the development of undifferentiated arthritis (UA) and rheumatoid arthritits (RA). Second, this thesis described a prediction model that estimates the chance to progress from UA to RA. The most important genetic risk factor for RA are the HLA-Class II alleles that encode for a common amino acid sequence, called the ‘Shared Epitope’. Investigating the progression to RA from UA revealed that the HLA-Shared Epitope alleles are not primarily a risk factor for RA but for the presence of anti-CCP antibodies, that are known to be specific for RA. Smoking in the presence of HLA-Shared Epitope alleles particularly increased the risk on anti-CCP-positive RA.. The HLA-DR3 alleles were associated with anti-CCP-negative RA. The presence of HLA-alleles encoding for D70ERAA correlated with a lower risk on RA and a less severe disease course. The presence of the PTPTN22 T-allele conferred an increased risk for both UA and RA. The knowledge on risk factors for RA-development was translated in a model that estimates the chance to progress to RA in patients that present with UA by using 9 clinical variables. The discriminative ability was high and this model allows individualized treatment decisions in UA. Show less