RESEARCH - Very recent onset arthritis: the value of initial rheumatologist evaluation and anti-CCP antibodies in the diagnosis of RA

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Clin Rheumatol. 2009 Oct;28(10):1135-9. Epub 2009 Jun 7.

Very recent onset arthritis: the value of initial rheumatologist

evaluation and anti-cyclic citrullinated peptide antibodies in the

diagnosis of rheumatoid arthritis.

Rojas-Serrano J, Burgos-Vargas R, Pérez LL, García CG, Moctezuma F,

Vázquez-Mellado J.

Instituto Nacional de Enfermedades Respiratorias, Ismael Cosío

Villegas, Universidad Nacional Autónoma de México, Faculty of

Medicine, Mexico City, Mexico.

The objective of this study is to identify baseline factors associated

with rheumatoid arthritis (RA) diagnosis at the end of 1-year

follow-up in a cohort of patients with very recent onset arthritis.

Incident cases with self-reported arthritis (<or=12 weeks) referred by

primary care physicians were assessed by a designated rheumatologist

who predicted in those with >or=1 swollen joint the diagnosis of RA at

the end of follow-up. Patients were regularly seen and diagnosed

through follow-up by staff rheumatologists who were blind to

diagnostic prediction. Of 119 referrals, 78 (65.5%; age 35.5 +/- 13.5

years; 69 females) were diagnosed at baseline as very recent onset

arthritis (median duration 6 weeks (0-12 weeks)); of 75 patients

completing 1-year follow-up, 51 (66.5%) were classified as RA; 12

(16%) had self-limited arthritis; and 13 (17.5%) other diagnoses. The

characteristics of patients with RA as final diagnosis were

polyarthritis, morning stiffness >or=1 h, high counts of swollen

joints, and low frequency of systemic symptoms. Rheumatologist

prediction of RA and anti-cyclic citrullinated peptide (anti-CCP)

antibodies was strongly associated with RA as a final diagnosis in the

logistic regression analysis. Sensitivity and specificity of the

rheumatologist prediction were 94% and 74%, for anti-CCP antibodies,

56% and 96%; the combination of both variables had a specificity of

100% and a sensitivity of 53%, and a positive predictive value of 98%.

The combination of RA as predicted diagnosis by a rheumatologist and

anti-CCP antibodies is highly specific for RA diagnosis in patients

with very early arthritis.

PMID: 19504230

http://www.ncbi.nlm.nih.gov/pubmed/19504230

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