title: Combining anti-cyclic citrullinated peptide with the American College of Rheumatology 1987 criteria failed to improve early rheumatoid arthritis diagnosis in the community-based very early arthritis cohort.
abstract: OBJECTIVE
  To test the performances of combining anti-CCP second generation (CCP2) with ACR 1987 classification criteria and to diagnose early RA in a community-based very early arthritis (VErA) patient cohort.
  
  
  METHODS
  The VErA cohort comprised 310 patients (median age 52 years; 68.1% women; median symptom duration 4.2 months; glucocorticoid- and DMARD naïve) conservatively treated during the first 2 years. At 6 years of follow-up, a three-expert committee classified the patients into three groups: RA, other classified arthritis (OCA) or unclassified arthritis (UA). We calculated the performances of the different sets, including anti-CCP2 positivity, while retaining or deleting RF and rheumatoid nodule components with ACR 1987 criteria for early RA diagnosis. Models were subjected to receiver operating characteristics curve and logistic regression analyses to try to identify relevant sets able to classify very early RA.
  
  
  RESULTS
  At 6 years, 149 patients were diagnosed as RA and 119 as non-RA (95 OCA and 24 UA). The original ACR 1987 criteria had 77.9% sensitivity and 64.7% specificity for the RA diagnosis at 6 years. The modified set excluding rheumatoid nodules, including anti-CCP2 positivity and retaining RF performed significantly better than ACR 1987 criteria, with 79.9% sensitivity and 64.7% specificity and with a larger area under the curve. However, in the zone of interest, i.e., ≥4/7 criteria, the curves for these sets were superimposed.
  
  
  CONCLUSIONS
  Adding anti-CCP2 positivity and deleting rheumatoid nodules failed to improve the performances of ACR 1987 classification criteria for the diagnosis of early RA.
authors.affiliation: Rheumatology Department, Rouen University Hospital and Inserm Unit 905, University of Rouen,, France. xavier.le-loet@chu-rouen.fr
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Victor
authors.initials: V
authors.lastname: Strotz
authors.forename: Thierry
authors.initials: T
authors.lastname: Lequerré
authors.forename: Patrick
authors.initials: P
authors.lastname: Boumier
authors.forename: Sophie
authors.initials: S
authors.lastname: Pouplin
authors.forename: Othmane
authors.initials: O
authors.lastname: Mejjad
authors.forename: Alain
authors.initials: A
authors.lastname: Daragon
authors.forename: Fabienne
authors.initials: F
authors.lastname: Jouen
authors.forename: Olivier
authors.initials: O
authors.lastname: Vittecoq
authors.forename: Patrice
authors.initials: P
authors.lastname: Fardellone
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Ménard
mesh_terms: D019540:Area Under Curve; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis*; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003151:Community Health Centers; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012217:Rheumatoid Factor / Q000097:blood
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor