[Early diagnosis of rheumatoid arthritis in modern clinical practice (results of a follow-up of a Moscow cohort of early arthritis patients participating in the program RADICAL)].
OBJECTIVE
To estimate potentialities of early diagnosis of rheumatoid arthritis (RA) diagnosis in clinical practice in the course of the RADICAL program.


METHODS
Of 366 patients participating in the trial 61 (16.7%) were males and 305 (83.3%) were females at the age of 47.76 +/- 14.1 years. The longest duration of the symptoms before consulting a doctor was 51 weeks, mean duration--5.7 weeks, 55% patients had the symptoms for 3 weeks. All the patients have undergone laboratory examination including leukocyte count, platelet count, estimation of ESR, concentration of C-reactive protein (CRP), rheumatoid factor (RF) and antibodies to a cyclic citrullated peptide (ACCP); roentgenography of the wrists and feet. On demand, antinuclear factor (ANF) and HLA-B27 were investigated. RA was diagnosed on the basis of ACR classification criteria. If the criteria were not complete at the moment of the study, the patient was referred to the group of "undifferentiated arthritis" (UA). The patients were examined before the treatment, 6 and 12 months later. The treatment was made according to Russian clinical recommendations.


RESULTS
Prior to admission to hospital, 58% patients were suspected for RA, 18.3%--osteoarthrosis (OA), 14%--reactive arthritis. 18.9% were not diagnosed, other diagnoses were considered in 12.6% patients. At primary examination RA was diagnosed in 212 (57.9%) patients, UA was in 133 (36.3%) patients, 21 (5.7%) patients had other diagnoses. Twelve months later RA, UA and other diseases were diagnosed in 256 (69.9%), 70 (19.1%) and 40 (10.9%) patients, respectively.


CONCLUSIONS
A 3-stage algorithm of early RA diagnosis is proposed. At the stage of the first contact with the patient in an outpatient clinic a valid RA suspition with consideration of modified EULAR criteria must be formulated. At the second stage a district rheumatologist must examine the patient outpatiently with determination of ACR classification criteria. In diagnosis verification the treatment must be started according to APP and EULAR clinical recommendations. If RA diagnosis can not be verified or rejected, the patient must be refered to hospital (stage 3). If verification of RA diagnosis is impossible, the diagnosis should be formulated as UA.
Karateev
D E
DE
Luchikhina
E L
EL
Tiurina
L N
LN
Chemeris
N A
NA
Pogozheva
E Iu
EIu
Lukina
G V
GV
Potanin
A Iu
AIu
Shostak
N A
NA
Kogan
K M
KM
Demidova
N V
NV
Kasumova
K A
KA
Pozdniakova
E S
ES
Fedorenko
E V
EV
Aleksandrova
E N
EN
Novikov
A A
AA
Smirnov
A V
AV
Nasonov
E L
EL
D000465:Algorithms; D000906:Antibodies / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D033023:Foot Joints / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009031:Moscow / Q000453:epidemiology; D010456:Peptides, Cyclic / Q000276:immunology; D011859:Radiography; D012189:Retrospective Studies; D012217:Rheumatoid Factor / Q000097:blood; D012720:Severity of Illness Index; D013997:Time Factors; D014505:Urban Population; D014955:Wrist Joint / Q000000981:diagnostic imaging*
D000906:Antibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor