title: Do we need to lower the cut point of the 2010 ACR/EULAR classification criteria for diagnosing rheumatoid arthritis?
abstract: OBJECTIVE
  In this study we aimed to evaluate the effect of lowering the cut point of the 2010 criteria to identify more patients with RA among early inflammatory arthritis patients.
  
  
  METHODS
  We included early arthritis patients from the Rotterdam Early Arthritis Cohort with at least one joint with clinical synovitis and symptoms for <1 year, with no other explanation for their symptoms. The demographic and clinical characteristics of each patient were recorded at baseline. Patients were classified as case or non-case at the 1-year follow-up by the definition used in the development of the 2010 criteria (MTX initiation). To assess the diagnostic performance of the 2010 criteria, the sensitivity and specificity at each cut point were determined.
  
  
  RESULTS
  We included 557 patients in our analysis. At the 1-year follow-up, 253 patients (45%) were classified as case (MTX use). In the group of patients who scored 0-5 points (n = 328), 98 patients (30%) were classified as case (MTX use). The sensitivity and specificity of the 2010 criteria using the cut point of 6 were 61% and 76%, respectively. With the cut point of 5, the sensitivity would increase to 76% and the specificity would decrease to 68%.
  
  
  CONCLUSIONS
  By lowering the cut point of the 2010 criteria from 6 to 5 points, we were able to identify 15% more RA patients at the cost of 8% more false-positive patients.
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, myrthe.vanderven@erasmusmc.nl.
authors.forename: Myrthe
authors.initials: M
authors.lastname: van der Ven
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
authors.forename: Celina
authors.initials: C
authors.lastname: Alves
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
authors.forename: Jolanda J
authors.initials: JJ
authors.lastname: Luime
authors.affiliation: Department of Rheumatology, Vlietland Hospital, Schiedam.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Gerards
authors.affiliation: Department of Rheumatology, Maasstad Hospital.
authors.forename: Pieternella J
authors.initials: PJ
authors.lastname: Barendregt
authors.affiliation: Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam.
authors.forename: Derkjen
authors.initials: D
authors.lastname: van Zeben
authors.affiliation: Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht.
authors.forename: Barbara
authors.initials: B
authors.lastname: van Schaeybroeck
authors.affiliation: Department of Rheumatology, Admiraal de Ruyter Hospital, Goes and.
authors.forename: Peter B J
authors.initials: PB
authors.lastname: de Sonnaville
authors.affiliation: Department of Rheumatology, Zorgsaam Hospital, Terneuzen, The Netherlands.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Grillet
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
authors.forename: Johanna M W
authors.initials: JM
authors.lastname: Hazes
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy; D015331:Cohort Studies; D042241:Early Diagnosis; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: classification criteria; diagnostic criteria; rheumatoid arthritis