Multicenter performance of the different classification criteria for rheumatoid arthritis

  • Cai-nan LUO ,
  • Zheng-fang LI ,
  • Li-jun WU ,
  • Hai-juan CHEN ,
  • Chun-mei YANG ,
  • Wen-hui XU ,
  • Xiao-ling LIU ,
  • Wei TANG ,
  • Ping QIAO ,
  • Baihetiya Rena
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  • 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 date: 2018-11-10

  Online published: 2020-10-15

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.

Cite this article

Cai-nan LUO , Zheng-fang LI , Li-jun WU , Hai-juan CHEN , Chun-mei YANG , Wen-hui XU , Xiao-ling LIU , Wei TANG , Ping QIAO , Baihetiya Rena . Multicenter performance of the different classification criteria for rheumatoid arthritis[J]. Journal of Peking University(Health Sciences), 2020 , 52(5) : 897 -901 . DOI: 10.19723/j.issn.1671-167X.2020.05.017

References

[1] 赵金霞, 苏茵, 刘湘源, 等. 早期类风湿关节炎分类标准及其诊断意义的探讨[J]. 中华风湿病学杂志, 2012,16(10):651-656.
[2] Zhao J, Su Y, Li R, et al. Classification criteria of early rheumatoid arthritis and validation of its performance in a multi-centre cohort[J]. Clin Exp Rheumatol, 2014,32(5):667-673.
[3] 李玉翠, 范文强, 陈海英, 等. 2012年早期类风湿关节炎分类标准的国内多中心临床验证[J]. 中华风湿病学杂志, 2017,21(12):807-811.
[4] 叶华, 苏茵, 李茹, 等. 早期类风湿关节炎分类标准的全国多中心临床验证[J]. 中华风湿病学杂志, 2014,18(12):802-805.
[5] Ye H, Su Y, Li R, et al. Comparison of three classification criteria of rheumatoid arthritis in an inception early arthritis cohort[J]. Clin Rheumatol, 2016,35(10):2397-2401.
[6] Radner H, Neogi T, Smolen JS, et al. Performance of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: A systematic literature review[J]. Ann Rheum Dis, 2014,73(1):114-123.
[7] van der Linden MP, Knevel R, Huizinga TW, et al. Classification of rheumatoid arthritis: Comparison of the 1987 American College of Rheumatology criteria and the 2010 American College of Rheumatology/European League Against Rheumatism criteria[J]. Arthritis Rheum, 2011,63(1):37-42.
[8] Biliavska I, Stamm TA, Martinez-Avila J, et al. Application of the 2010 ACR/EULAR classification criteria in patients with very early inflammatory arthritis: analysis of sensitivity, specificity and predictive values in the SAVE study cohort[J]. Ann Rheum Dis, 2013,72(8):1335-1341.
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