RESEARCH - Changes over time in the diagnosis of RA in a 10-year cohort

[Guest guest]

J Rheumatol. 2009 Oct 15. [Epub ahead of print]

Changes Over Time in the Diagnosis of Rheumatoid Arthritis in a 10-year Cohort.

Morvan J, Berthelot JM, Devauchelle-Pensec V, Jousse-Joulin S, Le

Henaff-Bourhis C, Hoang S, Thorel JB, A, Youinou P, Saraux A.

From the Department of Rheumatology and Department of Immunology,

University Hospital, Brest; Department of Rheumatology, University

Hospital, Nantes; Department of Rheumatology, Morlaix Hospital,

Morlaix; Department of Rheumatology, Vannes Hospital, Vannes;

Department of Rheumatology, Lorient Hospital, Lorient; and Department

of Rheumatology, Saint-Brieuc Hospital, Saint-Brieuc, France.

OBJECTIVE: We assessed levels of agreement between a diagnosis of

rheumatoid arthritis (RA) at inclusion in a recent-onset arthritis

cohort, then 2 and 10 years later. Performance of American College of

Rheumatology (ACR) criteria alone or combined with rheumatologist

diagnosis, and of recent new criteria adding antibodies to cyclic

citrullinated peptides ( " anti-CCP-revised criteria " ) to existing ACR

criteria, was evaluated.

METHODS: In total, 270 patients with recent-onset arthritis of less

than 1 year duration were included between 1995 and 1997 and followed

for 2 years. A diagnosis was recorded by an office-based

rheumatologist (OBR) at inclusion, then 2 years later. In 2007, a

questionnaire was sent to each rheumatologist to collect the final

diagnosis, which was considered the reference.

RESULTS: Final diagnosis was available for 164 patients: 57 had RA.

Agreement was low (kappa = 0.27) between the baseline and final

diagnoses, and substantial (kappa = 0.69) between the 2-year and final

diagnoses. Anti-CCP-revised criteria had sensitivity of 65% to 81% and

specificity of 55% to 75%. Sensitivity and specificity of ACR criteria

were 57.9% (44.1%-70.9%) and 74.8% (65.5%-82.7%) at inclusion, 80.7%

(70.5%-90.0%) and 63.6% (54.5%-72.7%) at 2 years. The combination OBR

diagnosis/ACR criteria after 2 years showed considerably increased

specificity (87% vs 64%) and slightly decreased sensitivity (77% vs

81%).

CONCLUSION: ACR criteria for RA showed poor performance even at 2

years. The absence of exclusion criteria may explain the lack of

specificity, which improved when combined with the OBR diagnosis.

Adding anti-CCP criteria to the existing criteria could help in

diagnosing RA.

PMID: 19833742

http://www.ncbi.nlm.nih.gov/pubmed/19833742

Not an MD