Ability of the American College of Rheumatology 1987 criteria to predict rheumatoid arthritis in patients with early arthritis and classification of these patients two years later

Abstract

Objective To determine how well the American College of Rheumatology (ACR; formerly, the American Rheumatism Association) 1987 classification criteria for rheumatoid arthritis (RA), when used at study inclusion in a cohort of 270 patients with early (<1 year) arthritis, predicted a diagnosis of RA 2 years later and how well they classified these patients at the end of the 2 years. Methods Patients were evaluated during 1995–1997 at 7 hospitals in the Brittany region of France. Patients were evaluated at 6‐month intervals until November 1999. The diagnosis made by a panel of 5 rheumatologists (P5R) after the last visit was used as the “gold standard.” The ACR 1987 criteria for RA were applied prospectively, without taking into account the initial diagnosis. Results At the last visit (mean ± SD followup 29.1 ± 11.8 months; median 30 months), the P5R diagnosed RA in 98 patients. At the last visit, classification by the ACR criteria was satisfactory, and the combination of an office‐based rheumatologist's (OBR's) diagnosis of RA and fulfillment of the ACR criteria was sensitive (87%; 85 of 98 RA patients had both) and highly specific (99%; 170 of 172 non‐RA patients did not have both). Application of the criteria at the first visit was of limited value for predicting a diagnosis of RA 2 years later. Conclusion After a 2‐year followup, the ACR 1987 classification criteria used in combination with an OBR's diagnosis were effective in distinguishing patients with and without RA. The criteria were not useful for predicting RA in patients with arthritis onset within the previous year. Some patients who met the criteria at baseline and after 2 years did not have RA, suggesting that incorporating exclusion criteria may improve the performance of the ACR criteria when used without taking into account the diagnosis by a rheumatologist, particularly in early arthritis.

The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort

“…An RA diagnosis is thus generally based upon the rheumatologist's opinion, perhaps after consideration of the ACR classification criteria 27 , as here. However, these criteria do not perform as well in early arthritis as they do in established RA 41 . Other criteria, such as those from the Leiden clinic 42 , have been developed to address early RA diagnosis more specifically.…”

Consenso da Sociedade Brasileira de Reumatologia 2011 para o diagnóstico e avaliação inicial da artrite reumatoide

“…[70][71][72] NEW CLASSIFICATION CRITERIA OF RA RA classifi cation has been essentially based on criteria introduced by the ACR in 1987, 73 and shown in Table 3, which are not suitable for early RA. 74 The ACR classifi cation criteria for RA were developed based on individuals with long-term RA, and were considered the standard for selecting patients for clinical studies. Such criteria have sensitivity of 91%-94% and specifi city of 89% for established RA.…”

Evaluation of Childhood Health Assessment Questionnaire in Juvenile Idiopathic Arthritis: A Single Center Experience From Turkey

“…3 In this study, we investigated the relationship between CHAQ and types of JIA, the disease activity, laboratory findings, and treatments of patients with JIA. Patients were diagnosed by a pediatric rheumatologist according to the American Rheumatology College criteria, 9,10 and classified as systemic, polyarticular and oligoarticular based on Durban Criteria. 11 All patients' ages, gender, disease type, age at disease onset, average followup durations and treatment were noted.…”