Diagnostic Accuracy of ACR/EULAR 2010 Criteria for Rheumatoid Arthritis in a 2-Year Cohort

2011 ◽  
Vol 38 (7) ◽  
pp. 1250-1257 ◽  
Author(s):  
SOPHIE VARACHE ◽  
DIVI CORNEC ◽  
JOHANNE MORVAN ◽  
VALÉRIE DEVAUCHELLE-PENSEC ◽  
JEAN-MARIE BERTHELOT ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Exclusion Criteria ◽  
Recent Onset ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Sensitivity Specificity ◽  
Tree Condition

Objective.To evaluate the diagnostic accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and 1987 ACR criteria for rheumatoid arthritis (RA), and the respective role of the algorithm and scoring of the ACR/EULAR.Methods.In total, 270 patients with recent-onset arthritis of < 1 year duration were included prospectively between 1995 and 1997 and followed for 2 years. RA was defined as the combination, at completion of followup, of RA diagnosed by an office-based rheumatologist and treatment with a disease-modifying antirheumatic drug or glucocorticoid. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the criteria sets in the overall population, in the subgroup meeting the tree condition for ACR/EULAR scoring, and in the overall population classified according the full tree.Results.At baseline, 111 of the 270 patients had better alternative diagnoses and 16 had erosions typical for RA; of the 143 remaining patients, 52 had more than 6 ACR/EULAR 2010 points (indicating definite RA) and 91 had fewer than 6 points. After 2 years, 11/16 patients with erosions and 40/52 with more than 6 points had RA. 100 of the 270 patients met the reference standard for RA. Sensitivity, specificity, PPV, and NPV of the ACR/EULAR (full tree) were 51/100 (51%), 153/170 (90%), 51/68 (75.4%), and 153/202 (75.7%), respectively. Diagnostic accuracies of the ACR/EULAR score and ACR 1987 criteria were not statistically different.Conclusion.Much of the improvement of the ACR/EULAR criteria was ascribable to the use of exclusion criteria in the algorithm.

Rheumatoid Arthritis: Etiology and Pathogenesis

2014 ◽  
Author(s):  
Gary S. Firestein ◽  
Anna-Karin H. Ekwall
Keyword(s):  
Rheumatoid Arthritis ◽  
Intracellular Signaling ◽  
Cartilage Damage ◽  
Signs And Symptoms ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Citrullinated Proteins ◽  
Definition Of

Rheumatoid arthritis (RA) is among the most common forms of chronic inflammatory arthritis. It affects approximately 1% of adults and is two to three times more prevalent in women than in men. There are no specific laboratory tests for RA; diagnosis depends on a constellation of signs and symptoms that can be supported by serology and radiographs. The disease evolves over many years as a consequence of repeated environmental stress causing inflammation and immune activation followed by a breakdown of tolerance in individuals with a specific genetic background. This review describes the definition of RA; its etiology, including genetics, infections, the role of smoking and citrullination of proteins, and epigenetic mechanisms; and its pathogenesis, including synovial histopathology, bone and cartilage damage, adaptive and innate immunity, and the role of cytokines and intracellular signaling. Tables include the 1987 American Rheumatism Association criteria for the classification of RA and the 2010 American College of Rheumatology/European League Against Rheumatism classification for RA. Figures show citrullinated proteins in airway cells, a section of a proliferative synovium from a patient with a classic RA, and scalloped regions of erosion at the junction between a proliferative inflamed rheumatoid synovium and the bone. This review contains 3 highly rendered figures, 2 tables, and 71 references.

scholarly journals The role of imaging in rheumatoid arthritis

2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Kgomotso Kgoebane ◽  
Mahmood M.T.M. Ally ◽  
Martha C. Duim-Beytell ◽  
Farhana E. Suleman
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Process ◽  
Classification Criteria ◽  
Reactive Protein ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Soft Tissue Involvement ◽  
Imaging Detection ◽  
Hands And Feet

Conventional radiographs of the hands and feet have traditionally been used in the diagnosis, management and monitoring of patients with rheumatoid arthritis (RA). However, they are not sensitive enough to detect changes early in the disease process. Erosions may only be visible up to two years after the onset of disease, and soft tissue involvement may not be detected at all. Early diagnosis can also be made challenging as markers such as erythrocyte sedimentation rate and C-reactive protein may be normal in up to 20% – 25% of cases. The latest classification criteria (American College of Rheumatology/European League Against Rheumatism [ACR/EULAR] Rheumatoid Arthritis Classification criteria 2010), often used to diagnose RA, incorporate the role of ultrasound and magnetic resonance imaging detection of synovitis, enabling earlier diagnosis and correct classification of patients. This article looks at the role of the various imaging modalities used in the diagnosis and management of RA.

scholarly journals P140 Validation of EULAR/ACR 2019 classification criteria for SLE in a south Indian juvenile SLE cohort

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Harikrishnan Bhaskaran Nair ◽  
Suma Balan
Keyword(s):  
Lupus Erythematosus ◽  
Predictive Value ◽  
Care Center ◽  
Tertiary Care ◽  
Classification Criteria ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
South Indian ◽  
European League Against Rheumatism ◽  
Sensitivity Specificity

Abstract Background To date there is no specific classification criteria for juvenile systemic lupus erythematosus (jSLE). Our aim is to compare the real world performance of EULAR/ACR 2019 criteria when applied to a known cohort of jSLE cases in Kerala, India. Methods We retrospectively reviewed the electronic medical record of all patients (n = 735), admitted under the Pediatric Rheumatology Department, Amrita Institute of Medical Sciences, Kochi, a tertiary care center in Kerala, India, during the period January 2012 to June 2019. 107 patients were diagnosed with jSLE by a qualified experienced pediatric rheumatologist and were independently assessed by an adult rheumatologist. Every sixth patient of the remaining 628 patients were selected as the control (n = 105). Patients were excluded if the diagnosis was uncertain or, if there was an overlap with jSLE. Each patient was evaluated to see if he or she satisfied the ACR-1997, SLICC-2012, or EULAR/ACR- 2019 criteria. Results Female: male ratio in cases and controls was 4.1:1 and 2.4 :1 respectively. Mean age for cases and controls was 12.6 +/-2.9 and 11.8 +/-3.5 respectively. The comparison of performance of each criterion is shown in table 1. Table 1: Validation of the EULAR/ACR 2019 SLE classification criteria using clinically diagnosed 107 jSLE cases. ACR- American College of Rheumatology; EULAR- European League Against Rheumatism; SLICC-Systemic Lupus International Collaborating Clinics; PPV- positive predictive value; NPV- negative predictive value Conclusion The new EULAR/ACR 2019 criteria achieved sensitivity, specificity, PPV, NPV and accuracy greater than SLICC 2012 criteria. It also achieved sensitivity, NPV and accuracy greater than 1997 ACR criteria. Disclosures H. Bhaskaran Nair None. S. Balan None.

Changes Over Time in the Diagnosis of Rheumatoid Arthritis in a 10-year Cohort

2009 ◽  
Vol 36 (11) ◽  
pp. 2428-2434 ◽  
Author(s):  
JOHANNE MORVAN ◽  
JEAN-MARIE BERTHELOT ◽  
VALÉRIE DEVAUCHELLE-PENSEC ◽  
SANDRINE JOUSSE-JOULIN ◽  
CATHERINE LE HENAFF-BOURHIS ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Poor Performance ◽  
Final Diagnosis ◽  
Exclusion Criteria ◽  
Recent Onset ◽  
American College Of Rheumatology ◽  
Acr Criteria ◽  
Changes Over Time ◽  
New Criteria ◽  
Over Time

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.

Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

2012 ◽  
Vol 15 (1) ◽  
pp. 12 ◽  
Author(s):  
Levent Sahiner ◽  
Ali Oto ◽  
Kudret Aytemir ◽  
Tuncay Hazirolan ◽  
Musturay Karcaaltincaba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Predictive Value ◽  
Artery Bypass ◽  
Time Interval ◽  
Mdct Angiography ◽  
Sensitivity Specificity

<p><b>Background:</b> The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).</p><p><b>Methods:</b> Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.</p><p><b>Results:</b> Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.</p><p><b>Conclusion:</b> Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.</p>

High disease activity is associated with higher blood pressure in recent onset rheumatoid arthritis patients, post-hoc analyses of IMPROVED study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Gegenava ◽  
SA Bergstra ◽  
H Maassen ◽  
CF Allaart
Keyword(s):  
Rheumatoid Arthritis ◽  
Blood Pressure ◽  
Disease Activity ◽  
Classification Criteria ◽  
Recent Onset ◽  
American College Of Rheumatology ◽  
Cardiovascular Morbidity And Mortality ◽  
The Difference ◽  
Post Hoc ◽  
Acpa Status

Abstract Funding Acknowledgements Type of funding sources: None. Background Rheumatoid arthritis (RA) is a chronic autoimmune disease with a high prevalence of cardiovascular morbidity and mortality. Purpose: purpose of our project was to investigate the association between disease activity and systolic and diastolic blood pressure (SBP, DBP) in patients with recent-onset rheumatoid arthritis (RA 2010 criteria) or undifferentiated arthritis (UA) who were treated to target disease activity score (DAS)&lt;1.6 in the IMPROVED study. Methods: The associations between disease activity and SBP/DBP were tested for 610 patients (364 RA, 246 UA), cross-sectionally and over time. GEE analyses were performed with both SBP and DBP as outcome measures and disease activity categories (DAS&lt;1.6;&gt;1.6 but ≤2.4; &gt;2.4), CRP level, treatment arms or the number of visits on a certain drug as potential predictors in separate analyses. Separate analyses tested potential contributions of gender, anti-cyclic citrullinated peptide antibodies (ACPA) status, and fulfilling the 2010 ACR/EULAR (American college of rheumatology/ European league against rheumatism) classification criteria. In addition association of BP with various levels of disease activity was tested with T-test. Results: At the baseline mean (SD) SBP was 133 (20) and DBP mean (SD) was 80 (10).  SBP &gt; 140mm Hg was observed in 40% of patients and DBP &gt; 90 mm Hg  in 21% of patients. SBP and DBP statistically significantly decreased during 5 years follow up (mainly during year 1), but the difference in mm Hg was small. Estimates from GEE analysis showed that patients with high DAS &gt;2.4 (HDAS) had a statistically significantly higher SBP (average 3 mm Hg higher, 95% CI 1.7; 4.2, p &lt; 0.01), than the patients in with DAS ≤2.4. ANOVA analyses showed a statistically significant association between SBP and DAS. In addition, post hoc analyses showed that patients with HDAS had a statistically significantly higher  SBP (mean (SD) 132 (19) than the patients with DAS &lt; 1.6 (remission) (mean (SD) 129 (20), p &lt; 0.01), and patients in LDAS but DAS≥1.6 had a statistically significantly higher SBP (mean (SD) 131 (19) than the patients in remission (mean (SD)  129 (20), p = 0.02) (Figure 1), whereas no association was found between DAS category and DBP. Gender, ACPA status or fulfilling the 2010 classification criteria did not influence the relation between DAS and blood pressure. Conclusions: In patients with RA or UA, a higher DAS is associated with higher blood pressure, but the clinical impact is unclear. Abstract Figure 1

Diagnostic accuracy of monofilament test to detect diabetic neuropathy

2021 ◽  
Vol 10 (1) ◽  
pp. 20-25
Author(s):  
Sujan Shrestha ◽  
Mamen Prasad Gorhaly ◽  
Manil Ratna Bajracharya
Keyword(s):  
Peripheral Neuropathy ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diabetic Peripheral Neuropathy ◽  
Perception Threshold ◽  
Sensitivity Specificity ◽  
Vibration Perception ◽  
Monofilament Test

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.  

THE SENSITIVITY, SPECIFICITY AND ACCURACY OF STATIC METHOD OF ULTRASONOGRAPHY TO CONFIRM ENDOTRACHEAL INTUBATION IN EMERGENCY DEPARTMENT.

2021 ◽  
pp. 8-13
Author(s):  
Pankaj Kumar Singh ◽  
Budhaditya Sanyal ◽  
Mohit Bhatnagar ◽  
Mandeep Joshi ◽  
Shreya Verma
Keyword(s):  
Diagnostic Accuracy ◽  
Endotracheal Tube ◽  
Predictive Value ◽  
Static Method ◽  
Tube Placement ◽  
Short Course ◽  
Endotracheal Tube Placement ◽  
Linear Probe ◽  
Post Intubation ◽  
Sensitivity Specificity

Aims and objectives: This study aims to assess the diagnostic accuracy and timeliness of ultrasonography by static method only for identication of Endotracheal tube (ET Tube) placement in the trachea in emergency settings vs existing clinical methods. Material and Methods: This prospective study was carried out in the emergency room from October 2018 till the end of March 2019. The ultrasonography was performed in 120 emergency patients only after the intubation had been completed ie, static phase. A linear probe was used over the neck to identify the predened signs of ET intubation. Residents who perform ultrasound examination ll a form after assessment of each patient. Results: It was found that Tracheal Intubation-USG Sensitivity was 99.1, Specicity was 91.7, Positive Predictive Value: 99.1, Negative Predictive Value was 91.7 and Accuracy was 98.3%. Ultrasonography can be used as an adjunct tool to verify the ETTposition by Emergency Physicians which can be performed easily after a brieng or short-course training.Conclusion:This study demonstrates that US imaging has a high diagnostic accuracy to immediately conrm proper ETT placement post-intubation in an emergency setup. Therefore, it seems that ultrasonography using a static technique only is a proper screening tool in determining endotracheal tube placement.

DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Tahir Iqbal ◽  
Muhammad Usman Shahid ◽  
Ishfaq Ahmad Shad ◽  
Shahzad Karim Bhatti ◽  
Syed Amir Gilani ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Color Doppler ◽  
Diagnostic Tools ◽  
Gray Scale ◽  
Versus Color ◽  
Sensitivity Specificity

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.

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