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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (5): 897-901. doi: 10.19723/j.issn.1671-167X.2020.05.017

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Multicenter performance of the different classification criteria for rheumatoid arthritis

Cai-nan LUO1,Zheng-fang LI1,Li-jun WU1,∆(),Hai-juan CHEN2,Chun-mei YANG2,Wen-hui XU3,Xiao-ling LIU4,Wei TANG2,Ping QIAO3,Baihetiya Rena4   

  1. 1. Department of Rheumatology and Immunology, People’s Hospital of Xinjiang Ugyur Autonomous Region, Urumuqi 830001, China
    2. Department of Rheumatology and Immunology, People’s Hospital of Changji, Changji 831100, Xinjiang, China
    3. Department of Rheumatology and Immunology, People’s Hospital of Aletai Region, Aletai 836500, Xinjiang, China
    4. Department of Rheumatology and Immunology, First People’s Hospital of Kashgar Region, Kashgar 844000, Xinjiang, China
  • Received:2018-11-10 Online:2020-10-18 Published:2020-10-15
  • Contact: Li-jun WU E-mail:wwlj330@126.com

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Abstract:

Objective: To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR). Methods: Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features. Results: (1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (χ 2=43.641, P<0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (χ2=0.446, P=0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (χ2=4.891, P=0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (χ2=0.044, P=1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (χ2=7.131, P=0.008; χ2=22.015, P<0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (χ2=0.220,P=0.755; χ2=0.473,P=0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836). Conclusion: The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.

Key words: Arthritis, Rheumatoid arthritis, Early diagnosis

CLC Number: 

  • R593.22

Table 1

Clinical charasteristics of ERA and non-ERA patients"

Items ERA(n=236) Non-ERA(n=89) P
Male/female, n 60/176 38/51 0.002
Age/years, x-±s 49.59±13.85 44.89±15.70 0.001
Disease duration/months, median (IQR) 5(2.25, 8.00) 3(1.00,10.00) 0.068
Swollen joint count, median (IQR) 5(2, 10) 2(1, 4) <0.001
Tender joint count, median (IQR) 11(6, 20) 4(2, 10) <0.001
Morning stiffness(>30 min), n(%) 151(63.98) 14(15.73) <0.001
RF positive, n(%) 162(68.64) 8(8.99) <0.001
Anti-CCP positive, n(%) 183(77.54) 6(6.74) <0.001
ESR/(mm/h), median (IQR) 41.50(24.00, 59.75) 27.00(14.00, 54.00) 0.008
CRP/(mg/L), median (IQR) 11.60(4.60, 36.38) 10.11(2.00, 46.48) 0.287

Table 2

Clinical charasteristics of patients with arthritis whose disease duration ≤3 months and ≤6 months"

Items Disease duration≤3 months(n=129) Disease duration≤6 months(n=220) P
Male/female, n 43/86 74/146 0.954
Age/years, x-±s 47.09±15.89 49.80±14.16 0.345
Swollen joint count, median (IQR) 4(1, 8) 4(1, 9) 0.688
Tender joint count, median (IQR) 7(3, 14) 8(4, 18) 0.063
Morning stiffness(>30 min), n(%) 66(51.16) 115(52.27) 0.841
RF positive, n(%) 56(43.41) 115(52.27) 0.110
anti-CCP positive, n(%) 62(48.06) 125(56.82) 0.113
ESR, mm/h, median (IQR) 39.00(20.75, 58.00) 40.00(22.00, 58.25) 0.758
CRP, mg/L, median (IQR) 13.26(3.04, 44.79) 11.60(4.17, 42.40) 0.839

Table 3

Sensitivity and specificity of 3 classification criterias in patients with arthritis"

Classification criteria Sensitivity/% Specificity/% Positive predictive value/% Negative predictive value/%
ERA 87.29 84.27 93.64 71.43
1987 ACR 60.59 94.38 96.62 47.45
2010 ACR/EULAR 85.17 86.52 94.37 68.75

Table 4

Sensitivity and specificity of 3 classification criterias in arthritis patients with disease duration ≤3 months"

Classification criteria Sensitivity/% Specificity/% Positive predictive value/% Negative predictive value/%
ERA 81.71 91.49 94.37 74.14
1987 ACR 54.88 100.00 100.00 63.51
2010 ACR/EULAR 79.27 93.62 95.59 72.13

Table 5

Sensitivity and specificity of 3 classification criterias in arthritis patients with disease duration ≤6 months"

Classification criteria Sensitivity/% Specificity/% Positive predictive value/% Negative predictive value/%
ERA 86.79 90.12 94.52 77.66
1987 ACR 64.15 97.53 98.08 25.00
2010 ACR/EULAR 83.02 91.36 94.96 73.27

Table 6

Comparision of consistency between clinical diagnosis and 3 classification criterias"

Items Consistency
rate/%		 Kappa P
Clinical diagnosis & ERA 86.46 0.678 <0.001
Clinical diagnosis & 1987 ACR 69.85 0.420 <0.001
Clinical diagnosis & 2010
ACR/EULAR		 85.54 0.663 <0.001

Table 7

Comparision of consistency among 3 classification criterias"

Items Consistency
rate/%		 Kappa P
ERA & 1987 ACR 78.15 0.577 <0.001
ERA & 2010 ACR/EULAR 92.31 0.836 <0.001
2010 ACR/EULAR & 1987 ACR 75.38 0.521 <0.001
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