Diagnostic performance of the ACR/EULAR 2010 criteria for rheumatoid arthritis and two diagnostic algorithms in an early arthritis clinic (REACH)

• Published in: Annals of the rheumatic diseases Vol. 70; no. 9; pp. 1645 - 1647
• Main Authors: Alves, Celina, Luime, Jolanda Jacoba, van Zeben, Derkjen, Huisman, Anne-Margriet, Weel, Angelique Elisabeth Adriana Maria, Barendregt, Pieternella Johanna, Hazes, Johanna Maria Wilhelmina
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.09.2011; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Group
• Series: Concise report
• Subjects: Adult; Aged; Algorithms; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Calibration; Clinical and Epidemiological Research; Diseases of the osteoarticular system; Early Diagnosis; Epidemiologic Methods; Female; Humans; Inflammatory joint diseases; Male; Medical sciences; Methotrexate - therapeutic use; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Patients; Probability; Proteins; Rheumatism; Rheumatoid arthritis; Rheumatology; Performance evaluation; Immunopathology; Chronic; Rheumatoid arthritis; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Arthritis; Diagnosis; Algorithm
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2010.142299

Introduction An ACR/EULAR task force released new criteria to classify rheumatoid arthritis at an early stage. This study evaluates the diagnostic performance of these criteria and algorithms by van der Helm and Visser in REACH. Methods Patients with symptoms ≤12 months from REACH were used. Algorithms were tested on discrimination, calibration and diagnostic accuracy of proposed cut-points. Two patient sets were defined to test robustness; undifferentiated arthritis (UA) (n=231) and all patients including those without synovitis (n=513). The outcomes evaluated were methotrexate use and persistent disease at 12 months. Results In UA patients all algorithms had good areas under the curve 0.79, 95% CI 0.73 to 0.83 for the ACR/EULAR criteria, 0.80, 95% CI 0.74 to 0.87 for van der Helm and 0.83, 95% CI 0.77 to 0.88 for Visser. All calibrated well. Sensitivity and specificity were 0.74 and 0.66 for the ACR/EULAR criteria, 0.1 and 1.0 for van der Helm and 0.59 and 0.93 for Visser. Similar results were found in all patients indicating robustness. Conclusion The ACR/EULAR 2010 criteria showed good diagnostic properties in an early arthritis cohort reflecting daily practice, as did the van der Helm and Visser algorithms. All were robust. To promote uniformity and comparability the ACR/EULAR 2010 criteria should be used in future diagnostic studies.