@article {GOSSEC2486, author = {LAURE GOSSEC and CHRISTOPHE COMBESCURE and NATHALIE RINCHEVAL and ALAIN SARAUX and BERNARD COMBE and MAXIME DOUGADOS}, title = {Relative Clinical Influence of Clinical, Laboratory, and Radiological Investigations in Early Arthritis on the Diagnosis of Rheumatoid Arthritis. Data from the French Early Arthritis Cohort ESPOIR}, volume = {37}, number = {12}, pages = {2486--2492}, year = {2010}, doi = {10.3899/jrheum.100267}, publisher = {The Journal of Rheumatology}, abstract = {Objective. To evaluate the relative level of influence of usual investigations in early arthritis on the diagnosis of rheumatoid arthritis (RA). Methods. Patients: those included in the ESPOIR early arthritis cohort, a national cohort of patients with grade >= 2 synovitis for \> 6 weeks and \< 6 months. The diagnostic properties of variables assessed at baseline were measured against the diagnosis of RA defined by American College of Rheumatology criteria (at any timepoint between inclusion and 12-month followup) and expert opinion. Various models, including (1) clinical data; (2) clinical + radiographic data (plain radiographs); (3) addition of rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (anti-CCP); and (4) addition of HLA-DR typing, were assessed by comparing areas under the curves for ROC curves. Results. Of 731 patients studied, 372 (50.9\%) satisfied criteria for RA at 1 year. In univariate analysis, sensitivity was highest for distal articular presentation (94.6\%), presence of IgM RF (69.4\%), pain on metatarso-phalangeal squeeze test (66.1\%), and presence of anti-CCP (65.6\%); whereas specificity was highest for nodules (100\%), HLA typing: shared-epitope double dose (95.9\%), radiographic erosions (86.5\%), and anti-CCP antibodies (86.4\%). The most efficient model included swollen joint count, morning stiffness, erosions, RF, and anti-CCP. Adding rheumatoid nodules, C-reactive protein, or HLA-DR information was not contributive. Conclusion. In addition to the clinical variables and radiographs, RF and/or anti-CCP are the single variables of interest that are contributive for the diagnosis of RA.}, issn = {0315-162X}, URL = {https://www.jrheum.org/content/37/12/2486}, eprint = {https://www.jrheum.org/content/37/12/2486.full.pdf}, journal = {The Journal of Rheumatology} }