Utility of a questionnaire of prognostic factors in the evaluation of patient with rheumatoid arthritis

There are few studies that have demonstrated the usefulness of prognostic factors in patients with RA using only variables commonly recorded in the clinical records at the beginning of the disease. The aim of our study was to elaborate a simple questionnaire (PPS: Poor Prognosis Score) to evaluate risk factors at the beginning of the illness classifying it in a mild, moderate or severe. We want to know if this simple questionnaire correlates with known variables of worst outcome such as incapacity, mortality, utilization of health services and surgery. Prognostic factors that have shown an association with the worse outcome of RA in different studies were revised. According to literature and published relative risks (RR) of associations, these can be classified as mild (RR <2.0), moderate (RR>2.0 and < 3.0), or strong (RR >3.0). In accordance with the levels of association, scores were given to the risk factors being 1 for those prognostic factors with mild association, 2 for those with moderate association, and 3 for those strongly associated with a poor prognosis. The PPS was created with the scores assigned. We excluded from the questionnaire variables not use ID a routine practice in our country such as HLA or although available of high cost for our country as the anti-citrulline antibodies. The chosen variables for the questionnaire were: Mild association: (1 point) age, sex, menopause, smoking, incomplete high school, low socioeconomic status, and depression. Moderate association: (2 points) ESR more than 40, C- Reactive protein 6 mg/dl, knee, elbows and, hands inflammation, and duration of RA more than 6 months without a DMARd treatment. Strong association: (3 points) Rheumatoid factor, presence of hand X- ray hand joints more than 20 joints affected at the beginning of disease, HAQ more than 1, and presence of extraarticular manifestations. Patients were classified in mild RA if the score were less than 10 points, moderate RA between 11 and 20 points and severe RA if the score was more than 20 points (best, no points, worst: 30 points). Questionnaire was applied to clinical records of patients. Those without all the information required were excluded from the analysis. We use EPIINFO 6.4 for the analysis and compare this classification against outcome variables. At the moment, 80 questionnaires have been applied. The patients are classified as with mild RA (25%), moderate RA (65 %), or severe RA (10%). A higher score of PPS, correlated significantly with the social status (P:0.04), involvement of knees, elbows, and hands (P: 0.0008), Longer time RA without treatment (P:0.0007),HAQ more than 1 (P:0.0001), positive rheumatoid factor (0.0008), and x-ray hand erosions (P:0.00003). When compare the groups according level of discapacity (HAQ score) comparing mild against moderate or severe RA and we found correlation with female sex (P:0.04), and more than 20 joints involved with synovitis (P:0.001). There was no association with other variables of outcome. A higher score of PPS correlated with different variables from a higher score of HAQ, which suggest and evaluation of different aspects of RA. The variables that correlated were of 3 points at PPS as erosions RF and a higher score from HAQ, or of 2 points as involvement of knees, elbows or hands and longer duration of RA without treatment. A low Socioeconomic status although has a low score at PPS (1 point) showed a significantly correlation with variables associated with severe AR according to PPS suggesting a strong relationship of poverty and bad prognosis of RA