RESEARCH - Sensitivity and specificity of the ACR 1987 criteria for the diagnosis of RA according to disease duration

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Ann Rheum Dis. Published Online First: 26 August 2008.

doi:10.1136/ard.2008.093187

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Extended Report

Sensitivity and specificity of the American College of Rheumatology

1987 criteria for the diagnosis of rheumatoid arthritis according to

disease duration: a systematic literature review and meta-analysis

Frédéric Banal 1*, Maxime Dougados 1, Christophe Combescure 2 and

Laure Gossec 1

1 Descartes University, Medicine Faculty; APHP, Rheumatology B

Department, Cochin Hospital, Paris, France

2 Department of Biostatistic, University Hospital of Nîmes, Nîmes, France

Abstract

Background: The American College of Rheumatology (ACR) 1987 revised

criteria for classification of rheumatoid arthritis (RA) are widely

used for diagnosis. Objective: To evaluate the ability of the ACR set

of criteria (both list and tree format) to diagnose RA compared to

expert opinion according to disease duration.

Methods: A systematic literature review was conducted in Pubmed and

Embase databases. All articles reporting the prevalence of RA

according to ACR criteria and expert opinion in cohorts of early (< 1

year duration) or established (>1 year) arthritis were analyzed to

calculate the sensitivity and specificity of ACR 1987 criteria against

the gold standard (expert opinion). A meta-analysis using S-ROC curve

was performed and pooled sensitivity and specificity were calculated

with confidence intervals.

Results: Among the 138 publications initially identified, 19 were

analysable (total:7438 patients, 3883 RA). In early arthritis, pooled

sensitivity and specificity of ACR set of criteria were 77% (68-84%)

and 77% (68-84%) in the list format versus 80% (72-88%) and 33%

(24-43%) in the tree format. In established arthritis, sensitivity and

specificity were respectively of 79% (71-85%) and 90% (84-94%) versus

80% (71-85%) and 93% (86-97%). The S-ROC meta-analysis confirmed the

statistically significant differences suggesting that diagnostic

performances of ACR list criteria are better in established arthritis.

Conclusion: This study indicates that specificity of ACR 1987 criteria

in early RA is low, and that these criteria should not be used as

diagnostic tools. However, sensitivity and specificity in established

RA are higher, which reflects their use as classification criteria

gold standard.

http://ard.bmj.com/cgi/content/abstract/ard.2008.093187v1?papetoc

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