title: Ability of hand radiographs to predict a further diagnosis of rheumatoid arthritis in patients with early arthritis.
abstract: 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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unit of Rheumatology and the Laboratory of Immunology, Hôpital de la Cavale Blanche, Brest, France.
authors.forename: V
authors.initials: V
authors.lastname: Devauchelle Pensec
authors.forename: A
authors.initials: A
authors.lastname: Saraux
authors.forename: J M
authors.initials: JM
authors.lastname: Berthelot
authors.forename: S
authors.initials: S
authors.lastname: Alapetite
authors.forename: G
authors.initials: G
authors.lastname: Chalès
authors.forename: C
authors.initials: C
authors.lastname: Le Henaff
authors.forename: J B
authors.initials: JB
authors.lastname: Thorel
authors.forename: S
authors.initials: S
authors.lastname: Hoang
authors.forename: I
authors.initials: I
authors.lastname: Nouy-Trolle
authors.forename: A
authors.initials: A
authors.lastname: Martin
authors.forename: D
authors.initials: D
authors.lastname: Baron
authors.forename: P
authors.initials: P
authors.lastname: Youinou
authors.forename: P
authors.initials: P
authors.lastname: Le Goff
mesh_terms: D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001175:Arthrography; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000000981:diagnostic imaging*; D006801:Humans; D007596:Joints / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016037:Single-Blind Method