PhD defence C. (Cleo) Rogier

Brief summary on the aim of the doctoral thesis:

Approximately 50% of patients with rheumatoid arthritis (RA) have autoantibodies, such as anti-citrullinated peptide antibodies (ACPA) and/or rheumatoid factor (RF). Due to extensive research it was found that autoantibodies can be detected years before the development of clinically apparent arthritis and that the onset of RA is preceded by a complex preclinical phase. The symptomatic arthralgia phase, without clinical apparent arthritis – also known as clinical suspect arthralgia (CSA), is the first opportunity to clinically recognize patients at risk for RA. Multiple studies in arthralgia patients have demonstrated autoantibodies to be the most powerful predictors for development of clinical arthritis, however the majority of arthralgia patients are ACPA negative.

Despite the heterogeneity in results, imaging is often used in clinical practice to guide management decision, and rheumatologist are increasingly willing to initiate ‘preventive’ treatment since evidence-based guidelines for the management of arthralgia patients are still absent. Hence, a more accurate risk stratification to recognize imminent RA still needs to be unraveled.

Therefore, the aim of this thesis is to elaborate on the existing knowledge by critically examining and refining (known) risk factors with a special focus on imaging. Additionally, we aimed to further understand the impact of CSA on our society by investigating the impact on work participation. To address this, arthralgia patients at risk for inflammatory arthritis development in four different Dutch observational, prospective cohorts were studied.