Changes over time in the diagnosis of rheumatoid arthritis in a 10-year cohort.
OBJECTIVE
We assessed levels of agreement between a diagnosis of rheumatoid arthritis (RA) at inclusion in a recent-onset arthritis cohort, then 2 and 10 years later. Performance of American College of Rheumatology (ACR) criteria alone or combined with rheumatologist diagnosis, and of recent new criteria adding antibodies to cyclic citrullinated peptides ("anti-CCP-revised criteria") to existing ACR criteria, was evaluated.


METHODS
In total, 270 patients with recent-onset arthritis of less than 1 year duration were included between 1995 and 1997 and followed for 2 years. A diagnosis was recorded by an office-based rheumatologist (OBR) at inclusion, then 2 years later. In 2007, a questionnaire was sent to each rheumatologist to collect the final diagnosis, which was considered the reference.


RESULTS
Final diagnosis was available for 164 patients: 57 had RA. Agreement was low (kappa = 0.27) between the baseline and final diagnoses, and substantial (kappa = 0.69) between the 2-year and final diagnoses. Anti-CCP-revised criteria had sensitivity of 65% to 81% and specificity of 55% to 75%. Sensitivity and specificity of ACR criteria were 57.9% (44.1%-70.9%) and 74.8% (65.5%-82.7%) at inclusion, 80.7% (70.5%-90.0%) and 63.6% (54.5%-72.7%) at 2 years. The combination OBR diagnosis/ACR criteria after 2 years showed considerably increased specificity (87% vs 64%) and slightly decreased sensitivity (77% vs 81%).


CONCLUSIONS
ACR criteria for RA showed poor performance even at 2 years. The absence of exclusion criteria may explain the lack of specificity, which improved when combined with the OBR diagnosis. Adding anti-CCP criteria to the existing criteria could help in diagnosing RA.
Morvan
Johanne
J
Department of Rheumatology, University Hospital, Brest, France.
Berthelot
Jean-Marie
JM
Devauchelle-Pensec
Valérie
V
Jousse-Joulin
Sandrine
S
Le Henaff-Bourhis
Catherine
C
Hoang
Sylvie
S
Thorel
Jean-Baptiste
JB
Martin
Antoine
A
Youinou
Pierre
P
Saraux
Alain
A
D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D001323:Autoantibodies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D012680:Sensitivity and Specificity; D013997:Time Factors
D018501:Antirheumatic Agents; D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide