Toward a data‐driven evaluation of the 2010 American College of Rheumatology/European League Against Rheumatism criteria for rheumatoid arthritis: Is it sensible to look at levels of rheumatoid factor?

Linden, M. P. M. van der; Batstra, Manou R.; Bakker-Jonges, Liesbeth E.; Detert, J.; Bastian, Hans; Scherer, Hans Ulrich; Toes, René E. M.; Burmester, Gerd R; Mjaavatten, Maria D; Kvien, Tore K; Huizinga, Tom W J; Mil, A.H.M. van der Helm-van

doi:10.1002/art.30200

Cited by 41 publications

(36 citation statements)

References 17 publications

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“…However, an appropriate discrimination of RA and OA is particularly difficult at later stages of the diseases, and the recent revision of the respective criteria has not significantly improved their diagnostic capability [20]. For instance, the presence of rheumatoid factor as a marker for RA has been questioned due to its high variability and should be replaced by the level of anti-citrullinated protein antibodies [21]. …”

Section: Introductionmentioning

confidence: 99%

Identification of rheumatoid arthritis and osteoarthritis patients by transcriptome-based rule set generation

et al. 2014

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IntroductionDiscrimination of rheumatoid arthritis (RA) patients from patients with other inflammatory or degenerative joint diseases or healthy individuals purely on the basis of genes differentially expressed in high-throughput data has proven very difficult. Thus, the present study sought to achieve such discrimination by employing a novel unbiased approach using rule-based classifiers.MethodsThree multi-center genome-wide transcriptomic data sets (Affymetrix HG-U133 A/B) from a total of 79 individuals, including 20 healthy controls (control group - CG), as well as 26 osteoarthritis (OA) and 33 RA patients, were used to infer rule-based classifiers to discriminate the disease groups. The rules were ranked with respect to Kiendl’s statistical relevance index, and the resulting rule set was optimized by pruning. The rule sets were inferred separately from data of one of three centers and applied to the two remaining centers for validation. All rules from the optimized rule sets of all centers were used to analyze their biological relevance applying the software Pathway Studio.ResultsThe optimized rule sets for the three centers contained a total of 29, 20, and 8 rules (including 10, 8, and 4 rules for ‘RA’), respectively. The mean sensitivity for the prediction of RA based on six center-to-center tests was 96% (range 90% to 100%), that for OA 86% (range 40% to 100%). The mean specificity for RA prediction was 94% (range 80% to 100%), that for OA 96% (range 83.3% to 100%). The average overall accuracy of the three different rule-based classifiers was 91% (range 80% to 100%). Unbiased analyses by Pathway Studio of the gene sets obtained by discrimination of RA from OA and CG with rule-based classifiers resulted in the identification of the pathogenetically and/or therapeutically relevant interferon-gamma and GM-CSF pathways.ConclusionFirst-time application of rule-based classifiers for the discrimination of RA resulted in high performance, with means for all assessment parameters close to or higher than 90%. In addition, this unbiased, new approach resulted in the identification not only of pathways known to be critical to RA, but also of novel molecules such as serine/threonine kinase 10.

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Section: Introductionmentioning

confidence: 99%

Identification of rheumatoid arthritis and osteoarthritis patients by transcriptome-based rule set generation

et al. 2014

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“…Using a significant DAS response of >1.2 to DMARD therapy as a validation tool for the new ACR/ EULAR 2010 criteria, van der Linden et al found a sensitivity and a specificity of 0.74 (both) [17,18]. Cader et al [25] found a sensitivity and specificity of 62 and 78 % for an adequate DMARD response.…”

Section: Discussionmentioning

confidence: 99%

“…In a clinical trial [15] and several single centre analyses [16][17][18], the new ACR/EULAR classification criteria have demonstrated superiority over the 1987 classification criteria. The 2010 ACR/EULAR criteria have been shown to classify more patients as RA who had formerly been considered as undifferentiated arthritis (UA) [19].…”

Section: Introductionmentioning

confidence: 99%

The new 2010 ACR/EULAR criteria as predictor of clinical and radiographic response in patients with early arthritis

et al. 2014

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New American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for the classification of rheumatoid arthritis (RA) have recently been proposed. The aim of this cohort study was to examine whether fulfilling these 2010 ACR/EULAR criteria at the first visit has an impact on the clinical course and on the radiographic progression of the disease. For this observational cohort study, we included patients from the Swiss RA registry SCQM with early RA or undifferentiated arthritis (UA, disease duration ≤1 year), as defined by the treating rheumatologist, who had not received any previous disease modifying anti-rheumatic drugs (DMARDs). Patients were categorized into two groups depending on whether or not they fulfilled the 2010 ACR/EULAR criteria (≥6 points vs <6 points) at the first visit. The primary outcome measures were the evolution of the DAS 28 and of radiographic erosions as measured by the Ratingen score over time. Of the 592 patients fulfilling the inclusion criteria, 352 satisfied the 2010 ACR/EULAR criteria at baseline, whereas 240 were not classifiable as definite RA. The ACR/EULAR criteria scores correlated with disease activity at disease onset (R (2) = 0.31). DMARD treatment was subsequently initiated in all patients, mostly with methotrexate (MTX). There were no significant differences in the therapeutic strategies between patients fulfilling or not fulfilling the classification criteria. Six months after inclusion, patients fulfilling the ACR/EULAR criteria developed a 39.1 % reduction of DAS 28 scores, as compared to a 33.6 % reduction in patients not fulfilling the ACR/EULAR criteria (p = 0.0002), independently of their respective treatment strategy. Importantly, the DAS 28 scores were higher in those patients fulfilling the ACR/EULAR criteria (ACR/EULAR positive patients) throughout the observation, as compared to patients not fulfilling those (ACR/EULAR negative patients). Average radiographic progression was higher among ACR/EULAR positive than negative patients (progression of Ratingen score/year 0.50 vs 0.32, resp., p = 0.03) after 3 years of follow-up. Among early RA/UA patients, a score of the 2010 ACR/EULAR criteria sufficient to classify RA selects patients with worse clinical outcome and more radiographic progression.

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“…When comparing the ACR/EULAR 2010 criteria with the van der Helm and Visser scores, a superior sensitivity (0.74 vs 0.1 vs 0.59), although lower specificity (0.66 vs 1.0 vs 0.93) was demonstrated for the ACR/EULAR criteria (10). Currently, the individual criteria of the ACR/EULAR 2010 criteria are being analyzed within other early arthritis cohorts with the aim of further improving its diagnostic value (11). …”

Section: Current Clinical Prediction Modelsmentioning

confidence: 99%

Can Synovial Pathobiology Integrate with Current Clinical and Imaging Prediction Models to Achieve Personalized Health Care in Rheumatoid Arthritis?

et al. 2017

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Although great progress has been made in the past decade toward understanding the pathogenesis of rheumatoid arthritis (RA), clinicians remain some distance from a goal of personalized health care. The capacity to diagnose RA early, predict prognosis, and moreover predict response to biologic therapies has been a research focus for many years. How currently available clinical prediction models can facilitate such goals is reviewed in this article. In addition, the role of current imaging techniques in this regard is also discussed. Finally, the authors review the current literature regarding synovial biomarkers and consider whether integration of synovial pathobiology into clinical prediction algorithms may enhance their predictive value.

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Toward a data‐driven evaluation of the 2010 American College of Rheumatology/European League Against Rheumatism criteria for rheumatoid arthritis: Is it sensible to look at levels of rheumatoid factor?

Abstract: Our findings indicate that determination of RF level is subject to large variation; high RF level has limited additive prognostic value compared to ACPA positivity. Thus, omitting RF level and using RF presence, ACPA presence, and ACPA level may improve the 2010 criteria for RA.

Cited by 41 publications

References 17 publications

Identification of rheumatoid arthritis and osteoarthritis patients by transcriptome-based rule set generation

Identification of rheumatoid arthritis and osteoarthritis patients by transcriptome-based rule set generation

The new 2010 ACR/EULAR criteria as predictor of clinical and radiographic response in patients with early arthritis

Can Synovial Pathobiology Integrate with Current Clinical and Imaging Prediction Models to Achieve Personalized Health Care in Rheumatoid Arthritis?

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