A 36-year-old woman is seen in a clinic for follow-up evaluation. She was diagnosed with rheumatoid arthritis 3 months ago and was started on methotrexate and hydroxychloroquine.
Which set of clinical features and serologic results at this visit is likely to predict the worst outcome in this patient?

Question

A 36-year-old woman is seen in a clinic for follow-up evaluation.  She was diagnosed with rheumatoid arthritis 3 months ago and was started on methotrexate and hydroxychloroquine.
Which set of clinical features and serologic results at this visit is likely to predict the worst outcome in this patient?

Quizplus · Accepted Answer

11ec193a_992b_ba18_853d_ef89597ee7ca_MD0002_00 Early identification of rheumatoid arthritis (RA) patients who have prognostic (predictive) factors for erosive disease can lead to more aggressive therapy with disease-modifying agents. Positive anti-cyclic citrullinated peptide (CCP) antibodies with high titers predict radiographic progression and poorer functional outcomes in RA (Choices A, D, and E).Involvement of a higher number of joints is also a risk factor for erosive disease.Patients with both positive rheumatoid factor and anti-CCP antibodies may benefit from more aggressive disease-modifying antirheumatic drug therapy compared to other patients (Choice B).In addition, elevated ESR and CRP may also predict RA disease activity with poorer outcomes. Positive anti-cyclic citrullinated peptide (CCP) antibodies with high titers predict radiographic progression and poorer functional outcomes in RA (Choices A, D, and E). Positive anti-cyclic citrullinated peptide (CCP) antibodies with high titers predict radiographic progression and poorer functional outcomes in RA (Choices A, D, and E). Involvement of a higher number of joints is also a risk factor for erosive disease. Involvement of a higher number of joints is also a risk factor for erosive disease. Patients with both positive rheumatoid factor and anti-CCP antibodies may benefit from more aggressive disease-modifying antirheumatic drug therapy compared to other patients (Choice B). Patients with both positive rheumatoid factor and anti-CCP antibodies may benefit from more aggressive disease-modifying antirheumatic drug therapy compared to other patients (Choice B). In addition, elevated ESR and CRP may also predict RA disease activity with poorer outcomes. In addition, elevated ESR and CRP may also predict RA disease activity with poorer outcomes. Other factors that predict erosive disease include severe functional limitations and persistent joint inflammation >12 weeks. Educational objective: Positive anti-cyclic citrullinated peptide (CCP) antibodies with high titers predict radiographic progression and poorer functional outcomes in rheumatoid arthritis. Patients with anti-CCP antibodies may benefit from more aggressive disease-modifying antirheumatic drug therapy compared to other patients. __________ References: Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis. (http://www.ncbi.nlm.nih.gov/pubmed/17434910) Prognostic value of anti-cyclic citrullinated peptide antibodies and rheumatoid factor in patients with rheumatoid arthritis. (http://www.ncbi.nlm.nih.gov/pubmed/20017459)

A 36-Year-Old Woman Is Seen in a Clinic for Follow-Up