title: Evaluation of clinical measures and different criteria for diagnosis of adult-onset Still's disease in a Chinese population.
abstract: OBJECTIVE
  To determine the value of clinical measures in diagnosis of adult-onset Still's disease (AOSD), and to identify the optimal set of proposed classification criteria, in a Chinese population.
  
  
  METHODS
  A total of 70 patients with AOSD and 140 non-AOSD inpatients with fever were retrospectively identified at Zhongshan Hospital, Shanghai, from January 2003 to December 2009. Clinical measures and 4 sets of diagnostic criteria (Yamaguchi, Calabro, Cush, and Reginato) were evaluated by sensitivity, specificity, positive/negative predictive value (PPV, NPV), and positive/negative likelihood ratio (PLR, NLR) for diagnosis of AOSD.
  
  
  RESULTS
  In our series, higher sensitivity included hyperpyrexia (temperature ≥ 39°C, 94.29%), arthralgia (80.0%), polymorphonuclear neutrophils (PMN) ≥ 75% (84.29%), serum ferritin ≥ 2-fold the upper normal value (90.0%), negative antinuclear antibodies (85.29%), and rheumatoid factor (84.38%); while higher specificity included transient erythema (98.57%), sore throat (85.0%), leukocytes ≥ 15,000/mm(3) (87.86%), and PMN ≥ 85% (85.0%). Rash, arthralgia, and sore throat were found to have better sensitivity and specificity (PLR 3.29-4.86). Leukocytes ≥ 10,000/mm(3), PMN ≥ 80%, and serum ferritin ≥ 5-fold the upper normal limit were set as critical points. The Reginato criteria set had the highest specificity, 99.29%. The Yamaguchi set had the highest sensitivity, 78.57%, with a better accuracy of 87.14%.
  
  
  CONCLUSIONS
  The Yamaguchi diagnostic criteria had better accuracy in Chinese patients. Indicators such as rash, arthralgia, sore throat, leukocytes ≥ 10,000/mm(3), PMN ≥ 80%, and serum ferritin ≥ 5-fold the upper normal limit were helpful for diagnosis of AOSD. We recommend using these indicators in combination instead of alone.
authors.affiliation: Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. zsh-rheum@hotmail.com
authors.forename: Lindi
authors.initials: L
authors.lastname: Jiang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Dai
authors.forename: Xuejuan
authors.initials: X
authors.lastname: Jin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People; D005260:Female; D005293:Ferritins / Q000097:blood; D005334:Fever / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016706:Still's Disease, Adult-Onset / Q000175:diagnosis* / Q000503:physiopathology*; D014894:Weights and Measures; D055815:Young Adult
chemical_list: D005293:Ferritins