Relative clinical influence of clinical, laboratory, and radiological investigations in early arthritis on the diagnosis of rheumatoid arthritis. Data from the French Early Arthritis Cohort ESPOIR.
OBJECTIVE
To evaluate the relative level of influence of usual investigations in early arthritis on the diagnosis of rheumatoid arthritis (RA).


METHODS



METHODS
those included in the ESPOIR early arthritis cohort, a national cohort of patients with grade ≥ 2 synovitis for > 6 weeks and < 6 months. The diagnostic properties of variables assessed at baseline were measured against the diagnosis of RA defined by American College of Rheumatology criteria (at any timepoint between inclusion and 12-month followup) and expert opinion. Various models, including (1) clinical data; (2) clinical + radiographic data (plain radiographs); (3) addition of rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (anti-CCP); and (4) addition of HLA-DR typing, were assessed by comparing areas under the curves for ROC curves.


RESULTS
Of 731 patients studied, 372 (50.9%) satisfied criteria for RA at 1 year. In univariate analysis, sensitivity was highest for distal articular presentation (94.6%), presence of IgM RF (69.4%), pain on metatarso-phalangeal squeeze test (66.1%), and presence of anti-CCP (65.6%); whereas specificity was highest for nodules (100%), HLA typing: shared-epitope double dose (95.9%), radiographic erosions (86.5%), and anti-CCP antibodies (86.4%). The most efficient model included swollen joint count, morning stiffness, erosions, RF, and anti-CCP. Adding rheumatoid nodules, C-reactive protein, or HLA-DR information was not contributive.


CONCLUSIONS
In addition to the clinical variables and radiographs, RF and/or anti-CCP are the single variables of interest that are contributive for the diagnosis of RA.
Faculty of Medicine, Paris Descartes University, UPRES-EA 4058, APHP, Department of Rheumatology B, Cochin Hospital, Paris, France. laure.gossec@cch.aphp.fr
Laure
L
Gossec
Christophe
C
Combescure
Nathalie
N
Rincheval
Alain
A
Saraux
Bernard
B
Combe
Maxime
M
Dougados
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D001323:Autoantibodies / Q000097:blood; D015331:Cohort Studies; D005602:France; D006801:Humans; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D012372:ROC Curve; D011859:Radiography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D001323:Autoantibodies; D010456:Peptides, Cyclic