[1]Peking University Third Hospital, Beijing, China.
Objective: The 1987 American College of Rheumatology (ACR) classification criteria for rheumatoid arthritis (RA) is not sensitive in early disease. Newly developed 2010 ACR/ European League Against Rheumatism (EULAR) classification criteria for RA may lead to over diagnosis in very early disease. This study was undertaken to develop classification criteria for early rheumatoid arthritis (1 year) based on large scale of early inflammatory arthritis patients and to evaluate the value of these criteria in diagnosing early RA patients in China. Methods: The study population comprised a cohort of patients from Department of Rheumatology and Immunology of 12 teaching hospitals who complained of joint swelling with symptom duration <1 year. The patients were classified into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists. A total of 803 patients were enrolled in this study. Of 514 patients were diagnosed as RA and 251 were as other rheumatic diseases, and 38 patients remained undiagnosed by the end of follow-up. Two different statistical methods were used to develop classification criteria. The clinical value of these criteria and 1987 ACR criteria were evaluated. Results: 1. The parameters with high sensitivity and/or specificity included morning stiffness lasting at least 30 minutes, symmetric arthritis, hand arthritis (swelling of wrist, MCP or PIP), arthritis of three or more joint areas, positive RF, positive anti-CCP antibody, and typical radiological changes of joints. 2. An early rheumatoid arthritis (E-RA) classification criteria were established based on the above items. The sensitivity of the E-RA criteria was 84.4%, which was much higher than that of 1987 ACR criteria (58.0%) based on the same cohort of early inflammatory arthritis patients, while the corresponding specificity of E-RA criteria was 87.4%, which was slightly decreased than that of 1987 ACR criteria (93.6%). The diagnostic value of the E-RA criteria was better than 1987 ACR criteria. 3. The sensitivity and specificity of logistic regression model criteria were 86.4% and 88.4%, respectively. 4. Area under the ROC curve (AUC) from these new criteria were 0.925 and 0.944, which were much higher than that from 1987 ACR criteria (AUC = 0.834). Conclusion: A set of early RA classification criteria is developed with higher sensitivity without obvious loss of specificity. It might serve as new classification criteria for early RA diagnosis in clinical practice and research.
(8.0+极速模式)