Ability of hand radiographs to predict a further diagnosis of rheumatoid arthritis in patients with early arthritis.
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.
Devauchelle Pensec
V
V
Unit of Rheumatology and the Laboratory of Immunology, Hôpital de la Cavale Blanche, Brest, France.
Saraux
A
A
Berthelot
J M
JM
Alapetite
S
S
Chalès
G
G
Le Henaff
C
C
Thorel
J B
JB
Hoang
S
S
Nouy-Trolle
I
I
Martin
A
A
Baron
D
D
Youinou
P
P
Le Goff
P
P
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