Performance of the American College of Rheumatology/European League Against Rheumatism 2010 criteria for the diagnosis of rheumatoid arthritis in Chinese patients.
OBJECTIVE
To evaluate the ability of American College of Rheumatology (ACR) 2010 classification criteria to diagnose rheumatoid arthritis (RA) compared to the widely used ACR 1987 criteria in Chinese patients.


METHODS
Four hundred and four patients suffering from arthritis were included in the study. Two hundred and twenty-one of them were classified as RA patients and 183 had alternative diagnoses. The patients were further subdivided into three groups according to their disease duration of within one year, one to two years or more than two years. The diagnostic value of ACR/EULAR 2010 criteria for RA was evaluated by comparing the sensitivity and specificity with those of ACR 1987 criteria in these patients.


RESULTS
The sensitivity and specificity of ACR/EULAR 2010 criteria for diagnosing RA were 95% and 92.9%, respectively. In contrast, the sensitivity and specificity of ACR 1987 criteria were 81.4% and 92.9%, respectively. The efficacy of ACR/EULAR 2010 criteria was superior to the ACR 1987 criteria by comparing their area under the curves (AUC) (0.940, 95% CI [0.912, 0.967] vs. 0.872, 95% CI [0.835, 0.909]). The recognition accuracy of ACR/EULAR 2010 criteria was higher than that of ACR 1987 criteria (94.5% vs. 86.6%, P<0.05). Inter-rater analysis showed that agreement of the two criteria was substantial (Kappa=0.744, P<0.001). For patients with disease duration within one year, one to two years and over two years, the sensitivities of ACR 1987 criteria were 69.2%, 81.3% and 89.9%, while the specificities were 94.4%, 90.6% and 92%, respectively. The corresponding sensitivities of ACR/EULAR 2010 criteria in these patients were 91%, 93.8% and 98.2%, while the corresponding specificities were 94.4%, 96.6% and 89.3%, respectively. The advantage of ACR/EULAR 2010 criteria over 1987 criteria in higher sensitivity was remarkable particularly in patients with disease duration within one year (P<0.001).


CONCLUSIONS
The ACR/EULAR 2010 criteria is more accurate in RA diagnosis compared to the ACR 1987 criteria by elevating the sensitivity while preserving the specificity, especially in patients with disease duration within one year. The ACR/EULAR 2010 criteria may serve as new diagnostic tools in daily clinical practice.
Department of Rheumatology and Clinical Immunology, Peking University First Hospital, 100034 Beijing, China.
Juan
J
Zhao
Guangtao
G
Li
Jing
J
Xu
Xiaohui
X
Zhang
Zhuoli
Z
Zhang
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000145:classification* / Q000175:diagnosis*; D044466:Asian People; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
Classification criteria; Rheumatoid arthritis; Sensitivity; Specificity