Ability of hand radiographs to predict a further diagnosis of rheumatoid arthritis in patients with early arthritis.

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Ability of hand radiographs to predict a further diagnosis of rheumatoid

arthritis in patients with early arthritis.

Devauchelle Pensec V, Saraux A, Berthelot JM, Alapetite S, Chales G, Le

Henaff C, Thorel JB, Hoang S, Nouy-Trolle I, A, Baron D, Youinou P,

Le Goff P.

Unit of Rheumatology and the Laboratory of Immunology, Hopital de la Cavale

Blanche, Brest, France.

OBJECTIVE: To evaluate the ability of hand radiographs collected at study

inclusion to predict a diagnosis of rheumatoid arthritis (RA) 2 years later,

in a cohort of patients with early arthritis. METHODS: We evaluated 270

patients with arthritis of less than one year duration. At the first visit,

all patients underwent a standardized evaluation including laboratory tests

and radiographs. Followup was 30+/-11.3 mo. The hand radiographs were read

by observers blinded to patient data who looked for item 7 of the 1987 ACR

criteria for RA and used Sharp's method to score erosions and joint space

narrowing. RESULTS: The kappa coefficient for ACR item 7 was < 0.65 for bony

decalcification and > 0.8 for erosions. Intra and interobserver correlation

coefficients for Sharp score ranged from 0.90 to 0.95. The " erosion "

component of ACR item 7 was more specific than the full item 7 (96% versus

87.5%; p = 0.02). Sharp erosion score was not better than the erosion

component of item 7 (sensitivity 17%; specificity 96%). CONCLUSION:

Regardless of the criterion used, hand radiographs were of limited value to

predict which patients would be considered as having RA 2 years later.

Diagnostic performance was similar for the " erosions " component of the 1987

ACR item 7 and for Sharp erosion score. The full 1987 ACR item 7 (erosions

or bony decalcification) performed less well.

Publication Types:

* Evaluation Studies

* Multicenter Study

PMID: 11764204 [PubMed - indexed for MEDLINE]