S Reneses1, L Pestana, A Garcia. 1. Department of Rheumatology, Virgen del Rocío University Hospital, Seville, Spain. srenesesc@telefonica.net
Abstract
OBJECTIVES: To compare the performance of the 1987 American College of Rheumatology (ACR) and the 2010 ACR/European League Against Rheumatism criteria for the classification of rheumatoid arthritis (RA). METHODS: Two-hundred and one patients aged 16 years or older with a 4-week to 12-month history of swelling of at least two joints and not previously treated with corticosteroids or disease-modifying anti-rheumatic drugs (DMARDs) were studied. The fulfilment of the 1987 and 2010 criteria was determined at baseline and at the end of the 1-year follow-up period. The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy of both sets of criteria were determined against three outcome measures: initiation of therapy with either methotrexate or any DMARD within the first year of follow-up, and clinical diagnosis according to physician's opinion after one year. RESULTS: At presentation, 145 patients fulfilled the 2010 criteria, and 108 the 1987 criteria for RA. The sensitivity, specificity and accuracy of the 2010 criteria were 0.80, 0.62 and 0.77 (0.58, 0.64 and 0.59 for the 1987 criteria) against the initiation of methotrexate therapy, 0.75, 0.73 and 0.75 (0.56, 0.91; 0.58 for the 1987 criteria) against the initiation of any DMARD therapy, and 0.87, 0.73 and 0.84 (0.69, 0.94; 0.75 for the 1987 criteria) against clinical diagnosis. CONCLUSIONS: Compared with the 1987 criteria, the 2010 criteria are more sensitive and accurate, but less specific against two of the three outcome measures used, and classify more patients with RA at earlier stages of the disease.
OBJECTIVES: To compare the performance of the 1987 American College of Rheumatology (ACR) and the 2010 ACR/European League Against Rheumatism criteria for the classification of rheumatoid arthritis (RA). METHODS: Two-hundred and one patients aged 16 years or older with a 4-week to 12-month history of swelling of at least two joints and not previously treated with corticosteroids or disease-modifying anti-rheumatic drugs (DMARDs) were studied. The fulfilment of the 1987 and 2010 criteria was determined at baseline and at the end of the 1-year follow-up period. The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy of both sets of criteria were determined against three outcome measures: initiation of therapy with either methotrexate or any DMARD within the first year of follow-up, and clinical diagnosis according to physician's opinion after one year. RESULTS: At presentation, 145 patients fulfilled the 2010 criteria, and 108 the 1987 criteria for RA. The sensitivity, specificity and accuracy of the 2010 criteria were 0.80, 0.62 and 0.77 (0.58, 0.64 and 0.59 for the 1987 criteria) against the initiation of methotrexate therapy, 0.75, 0.73 and 0.75 (0.56, 0.91; 0.58 for the 1987 criteria) against the initiation of any DMARD therapy, and 0.87, 0.73 and 0.84 (0.69, 0.94; 0.75 for the 1987 criteria) against clinical diagnosis. CONCLUSIONS: Compared with the 1987 criteria, the 2010 criteria are more sensitive and accurate, but less specific against two of the three outcome measures used, and classify more patients with RA at earlier stages of the disease.