PT  - JOURNAL ARTICLE
AU  - Johanne Morvan
AU  - Jean-Marie Berthelot
AU  - Valérie Devauchelle-Pensec
AU  - Sandrine Jousse-Joulin
AU  - Catherine Le Henaff-Bourhis
AU  - Sylvie Hoang
AU  - Jean-Baptiste Thorel
AU  - Antoine Martin
AU  - Pierre Youinou
AU  - Alain Saraux
TI  - Changes Over Time in the Diagnosis of Rheumatoid Arthritis in a 10-year Cohort
AID  - 10.3899/jrheum.090072
DP  - 2009 Oct 15
TA  - The Journal of Rheumatology
PG  - jrheum.090072
4099  - http://www.jrheum.org/content/early/2009/10/09/jrheum.090072.short
4100  - http://www.jrheum.org/content/early/2009/10/09/jrheum.090072.full
AB  - Objective We assessed levels of agreement between a diagnosis of rheumatoid arthritis (RA) at inclusion in a recent-onset arthritis cohort, then 2 and 10 years later. Performance of American College of Rheumatology (ACR) criteria alone or combined with rheumatologist diagnosis, and of recent new criteria adding antibodies to cyclic citrullinated peptides (“anti-CCP-revised criteria”) to existing ACR criteria, was evaluated. Methods In total, 270 patients with recent-onset arthritis of less than 1 year duration were included between 1995 and 1997 and followed for 2 years. A diagnosis was recorded by an office-based rheumatologist (OBR) at inclusion, then 2 years later. In 2007, a questionnaire was sent to each rheumatologist to collect the final diagnosis, which was considered the reference. Results Final diagnosis was available for 164 patients: 57 had RA. Agreement was low (κ = 0.27) between the baseline and final diagnoses, and substantial (κ = 0.69) between the 2-year and final diagnoses. Anti-CCP-revised criteria had sensitivity of 65% to 81% and specificity of 55% to 75%. Sensitivity and specificity of ACR criteria were 57.9% (44.1%–70.9%) and 74.8% (65.5%–82.7%) at inclusion, 80.7% (70.5%–90.0%) and 63.6% (54.5%–72.7%) at 2 years. The combination OBR diagnosis/ACR criteria after 2 years showed considerably increased specificity (87% vs 64%) and slightly decreased sensitivity (77% vs 81%). Conclusion ACR criteria for RA showed poor performance even at 2 years. The absence of exclusion criteria may explain the lack of specificity, which improved when combined with the OBR diagnosis. Adding anti-CCP criteria to the existing criteria could help in diagnosing RA.