title: Lessons from an international survey of paper cases of 10 real patients from an early arthritis clinic.  CRI (Club Rhumatismes et Inflammation) Group.
abstract: OBJECTIVE
  To determine how experts would classify 10 early-arthritis cases (7 atypical) and to study discrepancies in diagnoses relative to ACR criteria for rheumatoid arthritis (RA) or ESSG criteria for spondyloarthropathy (SpA).
  
  
  METHODS
  Ten real cases (5 met ACR criteria for RA, 6 ESSG criteria for SpA, 3 both and 2 neither) followed for 28.5 +/- 4.8 months were sent as paper cases to 20 international and 12 French experts. Each expert selected a diagnosis among 8 possible choices and rated it on a 0-10 confidence scale. For each case, 3 analog scales (0-100 mm) were used to indicate the probability of RA, SpA or undifferentiated arthritis (UA).
  
  
  RESULTS
  Experts often disagreed about diagnoses (up to 5 different diagnoses for a given case, with a mean of 3.9 per case). Similarly, expert opinions on probabilities for RA and SpA differed widely, with great overlap between confidence for RA, SpA and UA. Fulfilment of ACR or ESSG criteria was poorly related to the experts' diagnosis and evaluation of probabilities for RA and SpA. However, UA was a relatively infrequent choice (19%).
  
  
  CONCLUSIONS
  There was no general consensus about the nosology of early RA and SpA. Classification of atypical early arthritis was not resolved by currently available criteria for RA and SpA. This may have implications for therapy in early disease.
authors.affiliation: Department of Rheumatology, Nantes University Medical School, CHU Nantes, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Berthelot
authors.forename: M
authors.initials: M
authors.lastname: Klarlund
authors.forename: D
authors.initials: D
authors.lastname: McGonagle
authors.forename: H J
authors.initials: HJ
authors.lastname: Bernelot-Moens
authors.forename: A
authors.initials: A
authors.lastname: Calin
authors.forename: B
authors.initials: B
authors.lastname: Harrison
authors.forename: H R
authors.initials: HR
authors.lastname: Schumacher
authors.forename: K
authors.initials: K
authors.lastname: Kaarela
authors.forename: A A
authors.initials: AA
authors.lastname: Drosos
authors.forename: J L
authors.initials: JL
authors.lastname: Hülsemann
authors.forename: W H
authors.initials: WH
authors.lastname: Koh
authors.forename: Y T
authors.initials: YT
authors.lastname: Konttinen
authors.forename: L
authors.initials: L
authors.lastname: Punzi
authors.forename: K
authors.initials: K
authors.lastname: Tanimoto
authors.forename: H J
authors.initials: HJ
authors.lastname: Williams
authors.forename: F
authors.initials: F
authors.lastname: Wolfe
authors.forename: C A
authors.initials: CA
authors.lastname: Zerbini
authors.forename: A
authors.initials: A
authors.lastname: Saraux
mesh_terms: D000328:Adult; D017668:Age of Onset; D000554:Ambulatory Care Facilities; D001172:Arthritis, Rheumatoid / Q000145:classification* / Q000175:diagnosis*; D003625:Data Collection; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011336:Probability; D012219:Rheumatology / Q000592:standards / Q000706:statistics & numerical data*; D013122:Spinal Diseases / Q000145:classification* / Q000175:diagnosis*