POS1258 MISSING THE WINDOW OF OPPORTUNITY: EARLY ARTHRITIS CLINICS IN TIMES OF COVID-19

Background:The outcomes of patients with chronic inflammatory arthritis (IA), such as rheumatoid arthritis (RA), have dramatically improved over the past 20 years. Earlier identification of IA and prompter treatment institution have been key advancements, promoted by the constitution of Early Arthritis Clinics (EAC) and the development of more sensitive classification criteria for RA. The outbreak of new COronaVIrus Disease 2019 (COVID-19) has quickly become a global health emergency and has forced a rearrangement in the management of other non-COVID-19 diseases. The impact of the lock-down of the healthcare systems on chronic inflammatory diseases such as RA is expected to be significant but is at present unknown.Objectives:To assess the effects of the lock-down imposed by the COVID-19 pandemic on the referral and clinical presentation of patients with new-onset RA.Methods:Data were retrieved from the Pavia EAC inception cohort, established in 2005 for the early identification of patients with new-onset IA. Referral criteria to the EAC include: ≥3 swollen joints (SJ) and/or <3 SJ and positive squeeze test and/or <3 SJ and morning stiffness >30 min. Demographic and clinical characteristics of the patients are assessed at baseline and regularly over follow-up.At 31 Dec 2020, the Pavia EAC collects information on 2.508 patients. For this study, baseline characteristics of the patients referred in the semester following the COVID-19 lock-down (Jul-Dec 2020) were compared with: (i) patients referred in the semester immediately preceding the lock-down (Jul-Dec 2019); (ii) patients referred in the semester following the publication of the 2010 RA classification criteria (Jan-Jun 2011); (iii) patients referred in the semester preceding the publication of the 2010 criteria (Jul-Dec 2009).Results:In the semester following the lock-down imposed by the COVID-19 pandemic, there was a decrease in the referral of patients with new-onset suspected IA compared with previous periods (n=71 vs n=91 in the semester before the lock-down, n=96 in the first semester of 2011, n=101 in the second semester of 2009). Furthermore, fewer of the referred patients fulfilled RA criteria at presentation (36.6% vs 44.3%, 46.5% and 42.9% in the other semesters). Among patients with RA, more were autoantibody-positive (72% vs 50%, 49.1% and 52.2%). There was a trend for increased diagnostic delay in the overall cohort of RA after the COVID-19 lock-down (Figure 1A). The delay was particularly longer in autoantibody-positive patients, returning to the values seen before the introduction of the 2010 RA criteria (Figure 1B). In contrast, the few autoantibody-negative patients were referred earlier (Figure 1C). Disease activity at presentation was significantly higher in RA patients presenting after the lock-down compared with the progressive trend for reduction observed over the previous years, irrespective of the autoantibody status (Figure 1D-F). Such increase was determined by an inversion of the trend towards lower levels of objective parameters of inflammation, such as the swollen joint count (Figure 1G-I) and acute phase reactants, and a further increase in the secular trend towards worsening of patient-derived measures, such as the tender joint count and patient global assessment (Figure 1J-L).Figure 1.Effects of COVID-19 lock-down on new-onset RA at presentation.Conclusion:The COVID-19 pandemic is posing unprecedented challenges in the management of patients suffering from chronic diseases. RA has returned to be diagnosed outside the window of opportunity, with a significantly higher inflammatory burden at presentation. The many benefits of early diagnosis, which have dramatically changed the outcomes of autoantibody-positive RA, are at risk of vanishing in short times. Equally important, autoantibody-negative RA is at risk of further under-diagnosis and under-treatment.Disclosure of Interests:Bernardo D’Onofrio: None declared, Ludovico De Stefano: None declared, Bianca Lucia Palermo: None declared, Blerina Xoxi: None declared, Antonio Manzo: None declared, Carlomaurizio Montecucco Speakers bureau: BMS, Lilly, Sanofi, Pfizer, Galapagos, Roche, Novartis, Serena Bugatti Speakers bureau: BMS, Lilly, Sanofi, Pfizer, Galapagos

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Rheumatoid arthritis—diagnosis

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0110_update_003 ◽

2013 ◽

pp. 849-857

Author(s):

Daniel Aletaha ◽

Helga Radner

Keyword(s):

Rheumatoid Arthritis ◽

Early Arthritis ◽

Classification Criteria ◽

Joint Disease ◽

Acute Phase Reactants ◽

Specific Diagnosis ◽

Related Disease ◽

American College Of Rheumatology ◽

Systemic Rheumatic Diseases ◽

Seronegative Spondylarthropathies

Rheumatoid arthritis (RA) is among the most disabling form of chronic inflammatory joint disease. Not all forms of arthritis develop into RA; on the contrary, it may be very challenging to differentiate RA from cases of arthritis that are self-limiting or caused by another disease. Evaluation of early arthritis includes some basic steps, such as excluding trauma, crystal, or infectious-related disease, as well as considering additional features that may guide towards a specific diagnosis. If no specific diagnosis can then be made, the presentation can be labelled as undifferentiated arthritis. Typical differential diagnoses of RA include viral polyarthritis, seronegative spondylarthropathies, polymyalgia rheumatic, and other systemic rheumatic diseases. In 2010, new classification criteria were published that led to a change in the approach to RA. Compared to the previous criteria, the American College of Rheumatology (ACR) 1987 criteria, a scoring system was devised, appreciating the type and number of affected joints (up to 5 points), as well as serology (up to 3 points), elevated acute-phase reactants (1 point), and a symptom persistence of 6 weeks or longer (1 point). If 6 or more points are reached, then classifiable RA is present. Importantly, classification status, which is used for study purposes, is not always identical to the diagnostic status, which often leads to clinical treatment.

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P022 Audit of musculoskeletal ultrasound to optimise DMARD therapy among patients in a district general hospital

Rheumatology ◽

10.1093/rheumatology/keab247.021 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Michael Chen-Xu ◽

Dovenik Hyseni ◽

Katerina Achilleos

Keyword(s):

Chronic Pain ◽

Inflammatory Arthritis ◽

Significant Proportion ◽

Musculoskeletal Ultrasound ◽

Tender Joint Count ◽

Tender Joint ◽

Biologic Dmards ◽

Retrospective Audit ◽

The Impact ◽

Active Synovitis

Abstract Background/Aims Musculoskeletal ultrasound (MSUS) has utility in optimising the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologic DMARDs (bDMARDs) in patients with inflammatory arthritis. However, it is unclear whether this is useful among patients with concomitant chronic pain and/or fibromyalgia, who often have elevated disease activity scores. We aimed to evaluate the impact of MSUS on inflammatory arthritis patients with concomitant chronic pain and/or fibromyalgia who met criteria for treatment escalation in a district general rheumatology service. Methods We conducted a retrospective audit of inflammatory arthritis patients with concomitant chronic pain and/or fibromyalgia who were eligible for DMARD escalation and underwent a MSUS since 2017. Scanning was performed by either a trained rheumatologist or musculoskeletal ultrasonographer. Synovitis was assessed following OMERACT guidelines. Results 43 patients with inflammatory arthritis and concomitant chronic pain and/or fibromyalgia who underwent MSUS were identified. The mean age was 57.0 years (SD 15.6), and 34 patients (79%) were female. Rheumatoid arthritis was the most frequent diagnosis with 32 patients (74%), with psoriatic arthritis in 5 (12%), undifferentiated inflammatory arthritis in 4 (9%) and axial spondylarthritis (axSpA) in 2 (5%). 20 patients (47%) had a concurrent diagnosis of fibromyalgia. The median tender joint count among non-axSpA patients was 10 (IQR 4-15) and 2 (IQR 0-4) for swollen joints. MSUS was requested for consideration of a bDMARD switch in 21 patients (49%), a new bDMARD in 15 (35%), and starting an adjunctive csDMARD among 7 (16%). 34 patients (79%) were already established on csDMARDs, with 15 patients (35%) being on one or more, and methotrexate being the most prescribed csDMARD in 26 (76%). 14 patients (33%) were already established on bDMARDs, 9 (21%) had been on them previously and 20 (47%) were bDMARD naïve. Among those on bDMARDs, anti-TNFs agents were the most prescribed (71%). Active synovitis was identified in 17 patients (40%). Greyscale synovitis, tenosynovitis and enthesitis were seen in 30 (70%), 10 (23%) and 2 patients (5%), respectively. Erosions were identified in 12 patients (28%), with 2 (17%) having new erosions. 27 patients (63%) had either a csDMARD started (n = 7, 33%), or a bDMARD started (n = 11, 31%) or switched (n = 9, 25%) after MSUS. Those with fibromyalgia were less likely to start or switch DMARDs (8/20 patients, 40%) than those without (19/23 patients, 82.6%), Pchi-squared = 0.004. Furthermore, active synovitis on MSUS was associated with DMARD escalation (14/17 patients [82.4%] with synovitis versus 13/26 patients [50%] without; Pchi-squared = 0.03). Conclusion MSUS avoided unnecessary DMARD escalation in a significant proportion of patients with inflammatory arthritis and features of concomitant chronic pain and/or fibromyalgia (n = 26, 37%), potentially resulting in reduced patient exposure to harmful DMARD side effects, and cost savings for the service. Disclosure M. Chen-Xu: None. D. Hyseni: None. K. Achilleos: None.

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Reducing the incidence of predictors of cardio-metabolic disease and dysglycaemia with lifestyle modification in at-risk persons – results of further analyses of DIABRISK-SL in those below 18 years of age

BMC Medicine ◽

10.1186/s12916-019-1398-2 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Nikolaos Fountoulakis ◽

Mahen Wijesuriya ◽

Luigi Gnudi ◽

Martin Gulliford ◽

Janaka Karalliedde

Keyword(s):

Metabolic Disease ◽

At Risk ◽

Lower Incidence ◽

Lifestyle Modification ◽

Composite Endpoint ◽

Impaired Fasting Glycaemia ◽

Fasting Glycaemia ◽

Post Hoc ◽

The Impact ◽

New Onset

Abstract Background We have previously demonstrated in the DIABRISK-SL trial that a trimonthly pragmatic lifestyle modification (P-LSM), as compared to a 12-monthly LSM advice (C-LSM), significantly reduced the primary composite endpoint of predictors of cardio-metabolic disease (new onset type 2 diabetes (T2DM), hypertension, impaired glucose tolerance (IGT), impaired fasting glycaemia and markers of cardio-renal disease) in urban participants aged below 40 years with risk factors for T2DM. Main text We now report results of post hoc analyses for those aged below 18 (n = 1725) in three age groups, specifically of 6–10 years (P-LSM n = 77, C-LSM n = 59), 10–14 years (P-LSM n = 534, C-LSM n = 556) and 14–18 years (P-LSM n = 239, C-LSM n = 260). There was no effect of P-LSM on the primary endpoint in participants aged below 10 years. Participants aged 10–14 years in the P-LSM intervention as compared to C-LSM had a lower incidence of the primary combined endpoint (87 vs. 106 cases; incident rate ratio (IRR) = 0.85, 95% confidence intervals (CI) 0.72–1.01; P = 0.07), driven mainly by the lower incidence of new onset hypertension (24 vs. 37 cases; IRR = 0.67, 95% CI 0.49–0.91; P = 0.012). Participants aged 14–18 years in the P-LSM intervention had a lower incidence of the composite endpoint (36 vs. 54 cases; IRR = 0.73, 95% CI 0.57–0.94; P = 0.015) as well as a lower incidence of IGT (12 vs. 21 cases; IRR = 0.6, 95% CI 0.39–0.92; P = 0.02), new onset hypertension (6 vs. 15 cases; IRR = 0.43, 95% CI 0.25–0.76; P = 0.004), and new onset dysglycaemia (composite of new T2DM, IGT and impaired fasting glycaemia) (30 vs. 46 cases; IRR = 0.74, 95% CI 0.56–0.97; P = 0.03) compared to those assigned to the C-LSM intervention. Limitations of the analyses are the post hoc approach and the small number of events in each group. There were no differences in retention between the two groups. Conclusions Our results suggest that, in young South Asians aged between 10 and 18 years at risk of T2DM, a pragmatic lifestyle modification programme may reduce the incidence of predictors of T2DM and hypertension. There is a need for further studies in younger populations to evaluate the impact and feasibility of interventions to reduce the burden of T2DM and associated cardio-metabolic risk. Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0905-6

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Circular RNAs Hsa_circ_0002715 and Hsa_circ_0035197 in Peripheral Blood Are Novel Potential Biomarkers for New-Onset Rheumatoid Arthritis

Disease Markers ◽

10.1155/2019/2073139 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Qing Luo ◽

Jun Liu ◽

Biqi Fu ◽

Lu Zhang ◽

Yang Guo ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Lupus Erythematosus ◽

Peripheral Blood ◽

Circular Rnas ◽

Tender Joint Count ◽

Roc Curve Analysis ◽

Tender Joint ◽

Hematologic Disorder ◽

Potential Biomarker ◽

New Onset

This study is aimed at exploring the levels of peripheral blood circular RNAs (circRNAs) as biomarker candidates for the diagnosis of new-onset rheumatoid arthritis (RA). The selected twenty-two circRNAs in peripheral blood from new-onset RA patients and healthy controls (HC) were determined by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). The levels of hsa_circ_0002715, hsa_circ_0001947, hsa_circ_0000367, and hsa_circ_0035197 were significantly increased in the peripheral blood of new-onset RA patients than in the peripheral blood of HC. And, there were obvious differences in the above four peripheral blood circRNAs between new-onset RA patients and systemic lupus erythematosus (SLE) patients and ankylosing spondylitis (AS) patients. Moreover, there were obvious differences in hsa_circ_0001947 and hsa_circ_0035197 between new-onset RA patients and patients with undiagnosed arthritis (UA). Receiver operating characteristic (ROC) curve analysis suggested that the levels of hsa_circ_0002715 and hsa_circ_0000367 in peripheral blood could distinguish new-onset RA patients from the HC, AS patients, and SLE patients, and the levels of hsa_circ_0001947 and hsa_circ_0035197 in peripheral blood could distinguish new-onset RA patients from the HC, AS patients, SLE patients, and UA patients. The logistic regression model showed that the combination of hsa_circ_0002715 and hsa_circ_0035197 could provide the best diagnostic accuracy with an area under the curve (AUC) of 0.758 (sensitivity: 72.9%, specificity: 71.4%). Moreover, the levels of peripheral blood hsa_circ_0002715 were correlated with swollen joint count (SJC), tender joint count (TJC), disease duration, rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA), and hematologic disorder. And, the levels of peripheral blood hsa_circ_0035197 were correlated with hematologic disorder. This study suggests that the combination of hsa_circ_0002715 and hsa_circ_0035197 in peripheral blood may be a potential biomarker of patients with new-onset RA and may be associated with disease activity.

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Rheumatoid arthritis—diagnosis

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0110_update_002 ◽

2013 ◽

pp. 849-857

Author(s):

Daniel Aletaha ◽

Helga Radner

Keyword(s):

Rheumatoid Arthritis ◽

Early Arthritis ◽

Classification Criteria ◽

Joint Disease ◽

Acute Phase Reactants ◽

Specific Diagnosis ◽

Related Disease ◽

American College Of Rheumatology ◽

Systemic Rheumatic Diseases ◽

Seronegative Spondylarthropathies

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The impact of smoking on the activity of rheumatoid arthritis

ARS Medica Tomitana ◽

10.1515/arsm-2015-0046 ◽

2015 ◽

Vol 21 (4) ◽

pp. 201-205

Author(s):

Dusa Daniela ◽

Hanzu-Pazara Loredana ◽

Pana Camelia ◽

Tudorache Monica ◽

Suta Maria

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Smoking Status ◽

Demographic Variables ◽

Tender Joint Count ◽

Medical Clinic ◽

Tender Joint ◽

A Prospective Study ◽

The Impact ◽

Clinical Emergency

Abstract Smoking is the environmental factor involved in rheumatoid arthritis etiopathology. The data from the literature show that the smoking influence both the appearance and the development of rheumatoid arthritis. The study aims to analyzes how smoking affects disease activity. A prospective study was conducted on a sample of 264 rheumatoid arthritis patients who were registered with the Department of Rheumatology at the Medical Clinic II, Clinical Emergency Hospital “St. Andrew “, Constanta. We performed demographic variables, clinical and biological. We specifically inquiring smoking status and parameters of disease activity variables expressed by DAS28 and its variables. Smoking status was correlated with high and moderate active disease and ESR values and pacient global assessment. No statistically significantly correlated with CRP, tender joint count, swollen joint count. In conclusion, smoking influences disease activity.

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DISEASE COURSE IN EARLY RHEUMATOID ARTHRITIS: AN OBSERVATIONAL STUDY

Romanian Journal of Rheumatology ◽

10.37897/rjr.2016.1.2 ◽

2016 ◽

Vol 25 (1) ◽

pp. 14-19

Author(s):

Teodora Serban ◽

◽

Iulia Satulu ◽

Oana Vutcanu ◽

Mihaela Milicescu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Low Dose ◽

Mean Value ◽

Early Arthritis ◽

Classification Criteria ◽

Interquartile Range ◽

Number Of Patients ◽

Significant Difference ◽

Dose Oral ◽

The Impact

Background. In rheumatoid arthritis (RA), prompt diagnosis and initiation of disease-modifying treatment during the first months after disease onset – a period called “window of opportunity” – is significantly superior to the delayed start of the same therapy. Clinical remission is more frequently obtained in patients with a disease duration no longer than 4 months and is the main aim of the treatment, therefore the “treat to target” (T2T) and “tight control” strategies were proposed. Objective. The aim of this study is to evaluate the therapy used for patients with early RA (ERA) and the impact of this medication on the clinical outcomes at 12 months after the first evaluation. Methods. Patients with early arthritis who were referred to the Early Arthritis Research Center of Dr. I. Cantacuzino Hospital between 2010-2014 and who fulfilled the 2010 EULAR/ACR Classification Criteria for RA (and who did not satisfy classification criteria for other inflammatory rheumatologic diseases) were enrolled. Only patients who received treatment with Methotrexate (MTX) associated or not with corticosteroids (CS) and patients who fulfilled the classification criteria for RA but did not received any DMARDs therapy were enrolled. Results. Forty-three patients were enrolled in the study, 62.8% females, mean age 55.47±13.71 years, median (interquartile range) DAS28 5.07 (4.31-5.60), SDAI 29.02 (20.92-34.61). At the first presentation, 40 patients (93.0%) received treatment with Methotrexate (MTX) in doses ranging from 5 mg/week to 20 mg/week, with a mean dose of 11.16±4.47 mg/week, the most frequently used doses ranging from 10 mg/week to 15 mg/week. 26 patients (60.5%) received corticosteroids (CS), either oral or intra-articular. During the study both the total number of patients receiving MTX and the mean dose of MTX increased, while the number of patients receiving CS decreased and at the end of the study only low-dose oral CS were still administered in 8 patients. At 12 months, median (interquartile range) DAS 28 was 1.77 (1.43-3.16), SDAI 3.58 (2.32-11.82). The evolution under treatment assessed by DAS28 and SDAI wasn’t significantly different between patients who received, at baseline, MTX in association with CS (mean value: ΔDAS28=-2.58±1.72, ΔSDAI=-20.44±16.49) and those who received MTX monotherapy (mean value: ΔDAS28=-2.91±1.17, ΔSDAI=-21.80±9.89) (p>0.05). There was no significant difference in change from baseline of DAS28 and SDAI at 12 months between patients who received low-dose oral CS and those who received intermittent intra-articular CS (p>0.05). Conclusions. Treatment with MTX and/or CS led to clinical and laboratory improved outcomes at 12 months of follow-up. There was no significant difference regarding long-term outcomes between patients who received low dose oral CS and those who received intra-articular CS. As this study was performed on a relatively small number of real-life patients with ERA, the results obtained should be validated on larger cohorts of patients.

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Missing during COVID-19 lockdown: children with new-onset type 1 diabetes

10.21203/rs.3.rs-28594/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Devi Dayal ◽

Saniya Gupta ◽

Dhvani Raithatha ◽

Muralidharan Jayashree

Keyword(s):

At Risk ◽

Type 1 Diabetes ◽

Pediatric Population ◽

Middle Income ◽

Onset Type ◽

Middle Income Countries ◽

Healthcare Settings ◽

The Impact ◽

New Onset

Abstract The redistribution of healthcare resources for coronavirus 2019 (COVID-19) pandemic has resulted in unintentional neglect of essential non-COVID-19 care (1). In low- and lower-middle income countries (LMIC), the already overstretched healthcare systems have crumbled under the COVID-19 pressure (2). Additionally, hardline lockdown restrictions, and fear of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare settings have forced patients with non-COVID-19 illnesses to stay home and suffer until their illness deteriorates substantially, and sometimes irreversibly. The impact of COVID-19 on the pediatric population has so far been mild, except in children with comorbidities (3). However, children who develop new time-sensitive non-COVID-19 illnesses during the pandemic are at risk of worsening or death due to compromised access to hospital care. In particular, children with new-onset type 1 diabetes (T1D) may progress rapidly to diabetic ketoacidosis (DKA) if treatment with insulin is delayed, and are therefore at risk of increased morbidity and mortality.

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EP40 Real world efficacy of secukinumab: a single centre experience

Rheumatology ◽

10.1093/rheumatology/keaa109.039 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Tim Blake ◽

Nicola J Gullick

Keyword(s):

Clinical Trial ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Adverse Events ◽

Real World ◽

Response To Treatment ◽

Tender Joint Count ◽

Inadequate Response ◽

Tender Joint ◽

New Onset

Abstract Background Secukinumab was approved by NICE for patients with active ankylosing spondylitis and psoriatic arthritis in 2017. Clinical trial data suggests secukinumab is a useful treatment option in both conditions, but often real world experience differs greatly from clinical trial results. In addition, patients with more refractory disease are often excluded from clinical trials. Methods Patients starting secukinumab at UHCW were identified from the Blueteq funding database. Medical notes were reviewed retrospectively to assess response rates using BASDAI responses in Ankylosing spondylitis and PsARC responses in PsA. Patients who had previously had inadequate response to TNF inhibitors (PsA only) and severe psoriasis received 300mg secukinumab monthly; the remainder were prescribed 150mg monthly. Results 113 patients commenced secukinumab between June 2017 and April 2019 and had outcome data recorded. 59 patients (52%) had received previous biologic agents prior to secukinumab exposure. Patients with ankylosing spondylitis had high BASDAI (6.91.4) and spinal pain (7.71.4). 38 patients had an initial response to treatment. Secukinumab was effective in 39 patients (63%), and 37 (62%) continued treatment. In psoriatic arthritis, despite high levels of activity at baseline (mean tender joint count 10 8; swollen joint count 63, and 65% prior biologic exposure, high rates of response were seen. The majority of patients have continued treatment. Secukinumab was well tolerated in both patient groups with low rates of discontinuation due to adverse events (11 patients, 9%). Adverse events included recurrent infection (6), rash (1), mouth ulcers (1), vertigo (1), new onset cancer (1) and new onset Crohn’s (1) although rates were low overall. Patients with pre-existing uveitis did not develop exacerbations but low numbers of patients with prior uveitis were treated. Conclusion Secukinumab demonstrates high levels of efficacy even in a cohort of patients with longstanding PSA and AS with high rates of inadequate responses to other biologics. Secukinumab is well tolerated with low rates of discontinuation due to adverse events. Disclosures: T. Blake: None. N.J. Gullick: Honoraria; NG has received Honoraria from Abbvie, Eli Lilly, Novartis, UCB. Grants/research support; NG has received funding for research from Abbvie and Novartis.

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Level of agreement of the 1987 ACR and 2010 ACR/EULAR rheumatoid arthritis classification criteria: an analysis based on ESPOIR cohort data

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2011-200259 ◽

2011 ◽

Vol 71 (3) ◽

pp. 386-389 ◽

Cited By ~ 34

Author(s):

B Fautrel ◽

B Combe ◽

N Rincheval ◽

M Dougados

Keyword(s):

Rheumatoid Arthritis ◽

Structural Damage ◽

Classification Criteria ◽

Joint Involvement ◽

Tender Joint Count ◽

Tender Joint ◽

American College Of Rheumatology ◽

Cohort Data ◽

European League Against Rheumatism ◽

Level Of Agreement

BackgroundIn 2010, new classification criteria for rheumatoid arthritis (RA) were developed.ObjectiveTo assess agreement between 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria and the potential source of discordance, based on ESPOIR cohort data.Methods813 early arthritis patients were included in ESPOIR between 2002 and 2005. Between-criteria agreement was based on the κ coefficient. Discordance was explored by logistic regression.ResultsData for 811 patients were available, with their main characteristics as follows: women 77%, swollen joint count 7.2, tender joint count 8.4, disease activity score in 28 joints 5.2, rheumatoid factor 46%, anticitrullinated protein antibody (ACPA) 39%, structural damage 22%. At baseline, 579 (71.4%) patients met the 1987 ACR criteria and 641 (79.0%) the 2010 criteria. Agreement at baseline was discordant for 168 patients: 115 satisfied the 2010 criteria and 53 the 1987 criteria. Concordance between the two sets was fair, with a κ coefficient of 0.45 and 0.42 at baseline and year 2, respectively. The main sources of discordance were the number and symmetry of joint involvement, as well as ACPA status.Conclusion2010 ACR/EULAR criteria identified more patients with RA than did 1987 criteria. The 2010 criteria failed to identify RA patients with symmetrical seronegative arthritis and limited joint involvement.

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