Session 8: Prognosis & Clinical Prediction Rules

Facilitator: Bob Goodman

Objectives:

Residents will be able to:

* Explain what clinical prediction rules are, how they are developed and validated, and apply them in the care of their patients.

Case:

You are in clinic and seeing a 30-year-old woman complaining of pain in both wrists and ankles for the past month. She says the pain is intermittent and reports morning stiffness of about 30 minutes, as well as swelling of her wrists. She describes the pain as “7 out of 10.” She reports fatigue and occasional headaches, no fevers or rashes. She denies symptoms of depression. She is taking ibuprofen, prn, and takes no other medications. She has three children, ages 2,4, and 7, and works as a dental assistant. She does not smoke or drink. She is sexually active with one partner and uses condoms. On exam she is afebrile, BP 112/78, HR 70, with no evidence of arthritis on exam. Her CBC is normal, as are LFTs and hepatitis serology. Her rheumatoid factor is weakly positive and anticyclic citrullinated peptide antibodies (aCCP) are negative. She is concerned because she has a first cousin with rheumatoid arthritis and asks you what is the chance she will develop RA?

Reading:

van de Stadt LA, et al. A prediction rule for the development of arthritis in seropositive arthralgia patients. Ann Rheum Dis 2013;72:1920–1926.

Fletcher, Fletcher, and Fletcher, Clinical Epidemiology, Chapter 7, Prognosis

Prognosis and Prediction Rules: A Primer