{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T17:24:05Z","timestamp":1771608245130,"version":"3.50.1"},"reference-count":10,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"unspecified","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010663","name":"H2020 European Research Council","doi-asserted-by":"publisher","award":["714312"],"award-info":[{"award-number":["714312"]}],"id":[{"id":"10.13039\/100010663","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018286","name":"Dutch Arthritis Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018286","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["programma translationeel onderzoek"],"award-info":[{"award-number":["programma translationeel onderzoek"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,1,17]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Clinical expertise is paramount in medical decision-making. In the setting of arthralgia, this expertise is highly relevant in differentiating clinically suspect arthralgia (CSA) from other musculoskeletal symptoms. However, it remains unclear whether rheumatological expertise is also reliable in estimating the risk of progression to rheumatoid arthritis (RA) in CSA patients. Using clinical expertise is more time-efficient than applying criteria, such as the European Alliance of Associations for Rheumatology\/American College of Rheumatology (EULAR\/ACR) risk stratification criteria for RA development. This study assessed the accuracy of RA-risk estimation based on rheumatologists\u2019 clinical expertise and compared this to these criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>501 CSA patients from the Leiden CSA cohort and placebo arm of the TREAT EARLIER trial were studied. At baseline, rheumatologists estimated RA risk (0\u201310 Numeric Rating Scale) informed by history, physical examination and laboratory results. The EULAR\/ACR risk stratification criteria (without imaging) were calculated using baseline data. The outcome was RA development (2010 criteria) within 1 year, and the discrimination was compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on their expertise, rheumatologists estimated the risk of RA as a mean of 5 (SD 1.6) on a 0\u201310 scale. With an area under the curve (AUC) of 0.64 (95% CI 0.55 to 0.73), patients who did or did not develop RA were moderately differentiated. The RA risk was mainly overestimated compared with observed progression rates. In comparison, the EULAR\/ACR risk stratification criteria in the same patients yielded an AUC of 0.91 (95% CI 0.87 to 0.95).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rheumatologists\u2019 clinical expertise is inaccurate in assessing the risk of developing RA in patients with CSA, due to risk overestimation. This may support the use of established criteria when risk information has clinical or therapeutic implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>NTR4853-trial-NL4599<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006473","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:50:28Z","timestamp":1771606228000},"page":"e006473","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Rheumatologist\u2019s expertise in estimating risk of developing rheumatoid arthritis in patients with clinically suspect arthralgia: what is the value?"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6299-7653","authenticated-orcid":false,"given":"Stijn","family":"Claassen","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3251-0238","authenticated-orcid":false,"given":"Hanna W","family":"van Steenbergen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8572-1437","authenticated-orcid":false,"given":"Annette H M","family":"van der Helm-Van Mil","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026022008502101000_12.1.e006473.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.138461"},{"key":"2026022008502101000_12.1.e006473.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.49.11.916"},{"key":"2026022008502101000_12.1.e006473.3","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1093\/rheumatology\/kev431","article-title":"Clinical expertise and its accuracy in differentiating arthralgia patients at risk for rheumatoid arthritis from other patients presenting with joint symptoms","volume":"55","author":"van Steenbergen","year":"2016","journal-title":"Rheumatology (Sunnyvale)"},{"key":"2026022008502101000_12.1.e006473.4","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1016\/j.ard.2025.01.021","article-title":"EULAR\/ACR risk stratification criteria for development of rheumatoid arthritis in the risk stage of arthralgia","volume":"84","author":"van Steenbergen","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"2026022008502101000_12.1.e006473.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01193-X"},{"key":"2026022008502101000_12.1.e006473.6","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.1093\/rheumatology\/keae044","article-title":"Patient burden and joint inflammation during development of RA from arthralgia: is it similar in ACPA-positive and ACPA-negative disease?","volume":"63","author":"Khidir","year":"2024","journal-title":"Rheumatology (Oxford)"},{"key":"2026022008502101000_12.1.e006473.7","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1093\/rheumatology\/kex324","article-title":"Validation of the EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis","volume":"56","author":"Burgers","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"2026022008502101000_12.1.e006473.8","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21393"},{"key":"2026022008502101000_12.1.e006473.9","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.ard.2025.01.036","article-title":"How to treat undifferentiated arthritis today or tomorrow? A consideration of treatment recommendations in light of current evidence","volume":"84","author":"van der Helm-van Mil","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"2026022008502101000_12.1.e006473.10","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02219-9"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2025-006473","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:50:29Z","timestamp":1771606229000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2025-006473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,20]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/rmdopen-2025-006473"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2025-006473","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}