Article Figures & Data
Figures
- Figure 1.
Final diagnosis of rheumatoid arthritis (RA) in the overall population according to the ACR/EULAR criteria.
- Figure 2.
Receiver operating characteristic curve of the criteria sets in the subgroup meeting the 3 conditions for ACR/EULAR scoring (synovitis, no better alternative diagnosis, and no typical erosions; panel A; n = 143) and in the overall population (panel B; n = 270).
- Figure 3.
Receiver operating characteristic curve of each item identified by the logistic regression in the subgroup meeting the 3 conditions for ACR/EULAR scoring (synovitis, no better alternative diagnosis, and no typical erosions; panel A); and in panel B, the diagnostic value of the best combination of items in the Brittany cohort [(joint 0–5)/5 + (ACPA 0–3) + (RF 0–1) × 2 + (ACR4 0–1) × 2 + (ESR or CRP 0–1) × 2], where joint 0–5 indicates the ACR/EULAR joint score, ACPA 0–3 (negative, low, high), RF absence or presence of rheumatoid factors, ACR4 0–1 the absence or presence of item 4 in the ACR 1987 criteria set, ESR 0–1 the absence or presence of ESR elevation, and CRP 0–1 the absence or presence of CRP elevation, compared to the other criteria sets.
Tables
- Table 1.
Prevalence of each item of the unmodified ACR 1987 criteria, modified ACR 1987, and ACR/EULAR criteria in patients with and without a final diagnosis of RA after 2 years, defined as RA diagnosed by the office-based rheumatologist and receiving disease-modifying antirheumatic drug and/or glucocorticoid therapy.
Item Final Diagnosis of RA p No, N = 170, n (%) Yes, N = 100, n (%) 1. Morning stiffness ≥ 1 hour* 59 (34.7) 68 < 0.0001 2. Arthritis of 3 or more joint areas* 74 (43.5) 78 < 0.0001 3. Arthritis of hand joints* 76 (44.7) 82 < 0.0001 4. Symmetric arthritis* 61 (35.9) 77 < 0.0001 5. Rheumatoid nodules 0 (0) 3 < 0.0001 6. Rheumatoid factor (positive) 24 (14.1) 57 < 0.0001 Low 14 (8.2) 24 High 10 (5.9) 33 7. Radiographic changes 10 (5.9) 11 0.15 8. ACPA (positive) 11 (6.4) 48 < 0.0001 Low 2 (1.2) 5 High 9 (5.3) 43 ACR 1987 criteria ≥ 4 34 (20) 64 < 0.0001 ACR 1987 Liao 2 modified criteria ≥ 3 58 (34.1) 84 < 0.0001 ACR 1987 Liao 1 modified criteria ≥ 4 34 (20) 69 < 0.0001 Joint involvement, points 0 78 (45.9) 17 1 14 (8.2) 3 2 42 (24.7) 26 < 0.0001 3 22 (12.9) 31 5 14 (8.2) 23 More than 6 weeks (1 point) 120 (70.6) 83 0.028 Elevated ESR or CRP (1 point) 121 (71.2) 81 0.08 RF or ACPA, points 0 132 (77.6) 29 2 13 (76.5) 11 < 0.0001 3 17 (10) 49 ACR/EULAR ≥ 6 24 (14.1) 58 < 0.0001 -
↵* More than 6 weeks. RF: rheumatoid factor; ACPA: anticyclic citrullinated peptide antibodies; ESR: erythrocyte sedimentation rate; CRP: serum C-reactive protein; ACPA: anticyclic citrullinated peptide antibodies.
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- Table 2.
Diagnostic value of the 3 criteria sets (unmodified ACR 1987, modified ACR 1987 criteria, and more than 6 points on the ACR/EULAR score), and of the best combination of items in the Brittany cohort in the overall population, in the subgroup meeting the 3 conditions for ACR/EULAR scoring (synovitis, no better alternative diagnosis, and no radiographic erosion typical for RA), and in the overall population classified according to the full ACR/EULAR tree.
Criteria Subgroups Sensitivity, % (95% CI) Specificity, % (95% CI) Positive Predictive Value, (95% CI) Negative Predictive Value, (95% CI) AUC* ACR 1987 criteria, ≥ 4 Overall 64/100, 64 (53.7–73.2) 136/170, 80 (73.0–85.6) 64/98, 65.3 (54.9–74.4) 136/172, 79.1 (72.1–84.71) 0.81 Conditions met 50/78, 64.1 (52.4–74.4) 43/65, 66.1 (53.2–77.1) 50/72, 69.4 (58.4–79.5) 43/71, 60.6 (48.2–71.7) 0.74 Full tree 61/100, 61 (50.7–70.4) 151/170, 88.8 (82.9–92.9) 61/88, 69.3 (58.4–78.5) 143/182, 78.6 (71.8–84.1) ACR 1987 criteria with Liao 2 modification, ≥ 3 Overall 69/100, 69 (58.9–77.7) 136/170, 80 (73.3–85.6) 69/98, 70.4 (60.2–78.9) 136/172, 79.1 (72.1–84.7) 0.81 Conditions met 67/78, 85.9 (75.7–92.4) 36/65, 55.4 (42.6–67.5) 67/96, 69.8 (59.5–78.5) 36/47, 76.6 (61.6–87.2) 0.77 Full tree 72/100, 72 (61.9–80.3) 144/170, 84.7 (78.2–89.6) 78/112, 69.6 (60.1–77.8) 136/158, 86.1 (79.5–90.9) ACR 1987 criteria with Liao 1 modification, ≥ 4 Overall 84/100, 84 (75.0–90.3) 112/170, 65.9 (58.2–72.9) 84/142, 59.1 (50.6–67.2) 112/128, 87.5 (80.2–92.5) 0.83 Conditions met 54/78, 69.2 (57.6–78.9) 43/65, 66.1 (53.2–77.1) 54/76, 71.0 (59.3–80.6) 43/67, 64.2 (51.5–75.3) 0.77 Full tree 65/100, 65 (54.7–74.1) 143/170, 84.1 (77.5–89.1) 65/92, 70.6 (60.1–79.4) 143/178, 80.3 (73.6–85.8) ACR/EULAR score ≥ 6 Overall 58/100, 58 (47.7–67.7) 143/170, 85.9 (79.5–90.6) 58/82, 70.7 (59.5–79.9) 146/188, 77.6 (70.9–83.3) 0.83 Conditions met 40/78, 51.3 (39.8–62.7) 53/65, 81.5 (69.6–89.7) 40/52, 76.9 (62.8–87) 53/91, 58.2 (47.4–68.3) 0.78 Full tree 51/100, 51 (40.9–61.1) 153/170, 90 (84.2–93.9) 51/68, 75 (84.2–93.9) 153/202, 75.7 (69.1–81.4) Best combination of items in the Brittany cohort ≥ 5 Overall 62/100, 62 (51.7–71.4) 145/170, 85.3 (78.9–90.1) 62/87, 71.3 (60.4–80.2) 145/183, 79.2 (72.5–84.7) 0.84 Conditions met 50/78, 64.1 (52.4–74.4) 53/65, 81.8 (69.6–89.7) 50/62, 80.6 (68.2–89.2) 53/81, 65.4 (53.9–75.4) 0.83** Full tree 61/100, 61 (50.7–70.4) 153/170, 90 (84.2–93.9) 61/88, 69.3 (58.4–78.5) 153/192, 79.7 (73.2–84.9) - Table 3.
Logistic regression in the group that was not better explained by another diagnosis and without erosion typical for RA.
Criteria Exp ß (95% CI) p Symmetric arthritis (ACR criteria 4) 2.96 (1.19–7.37) 0.02 Rheumatoid factor (positive or negative) 3.23 (1.27–8.22) 0.014 Cyclic citrullinated peptide (negative, low, high) 2.90 (1.6–5.23) < 0.0001 ESR or CRP 2.67 (1.01–7.05) 0.03 Joint (0 to 5 points) 1.33 (1.02–1.73) 0.032 -
ESR: erythrocyte sedimentation rate; CRP: C-reactive protein.
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