Assessment of the New 2012 EULAR/ACR Clinical Classification Criteria for Polymyalgia Rheumatica: A Prospective Multicenter Study

2016 ◽  
Vol 43 (5) ◽  
pp. 893-900 ◽  
Author(s):  
Gulsen Ozen ◽  
Nevsun Inanc ◽  
Ali Ugur Unal ◽  
Seda Bas ◽  
Gezmis Kimyon ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Polymyalgia Rheumatica ◽  
Area Under The Curve ◽  
Classification Criteria ◽  
Lower Sensitivity ◽  
Clinical Classification ◽  
Acute Phase Reactants ◽  
Clinical Criteria ◽  
American College Of Rheumatology ◽  
Multicenter Prospective Study

Objective.To assess the performance of the new 2012 provisional European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) polymyalgia rheumatica (PMR) clinical classification criteria in discriminating PMR from other mimicking conditions compared with the previous 5 diagnostic criteria in a multicenter prospective study.Methods.Patients older than 50 years, presenting with new-onset bilateral shoulder pain with elevated acute-phase reactants (APR), were assessed for the fulfillment of the new and old classification/diagnostic criteria sets for PMR. At the end of the 1-year followup, 133 patients were diagnosed with PMR (expert opinion) and 142 with non-PMR conditions [69 rheumatoid arthritis (RA)]. Discriminating capacity, sensitivity, and specificity of the criteria sets were estimated.Results.Discriminating capacity of the new clinical criteria for PMR from non-PMR conditions and RA as estimated by area under the curve (AUC) were good with AUC of 0.736 and 0.781, respectively. The new criteria had a sensitivity of 89.5% and a specificity of 57.7% when tested against all non-PMR cases. When tested against all RA, seropositive RA, seronegative RA, and non-RA control patients, specificity changed to 66.7%, 100%, 20.7%, and 49.3%, respectively. Except for the Bird criteria, the 4 previous criteria had lower sensitivity and higher specificity (ranging from 83%–93%) compared with the new clinical criteria in discriminating PMR from all other controls.Conclusion.The new 2012 EULAR/ACR clinical classification criteria for PMR is highly sensitive; however, its ability to discriminate PMR from other inflammatory/noninflammatory shoulder conditions, especially from seronegative RA, is not adequate. Imaging and other modifications such as cutoff values for APR might increase the specificity of the criteria.

THU0293 PREDICTORS OF LONG-TERM THERAPY WITH GLUCOCORTICOID IN POLYMYALGIA RHEUMATICA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 374-375
Author(s):  
A. Aoki ◽  
H. Kobayashi
Keyword(s):  
Polymyalgia Rheumatica ◽  
Clinical Symptoms ◽  
Therapy Group ◽  
Classification Criteria ◽  
Term Therapy ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Long Term Therapy ◽  
European League

Background:Polymyalgia rheumatica (PMR) is a common inflammatory condition of elderly persons. Clinical symptoms respond to low-dose glucocorticoids (GC), but treatment is often required for several years. 2015 EULAR/ACR recommendations1)recommend considering early introduction of methotrexate (MTX) in addition to GC, particularly in patients at a high risk for relapse and/or prolonged therapy. However, risk factors for prolonged therapy are not clear yet.Objectives:We investigated predictive factors which corresponded to the long-term GC therapy.Methods:This was a retrospective study in a single general hospital in Japan. We reviewed the medical records of the Japanese patients with PMR between April 2011 and January 2020. Diagnosis of PMR was based on Bird’s criteria or 2012 EULAR/ACR Classification Criteria2). All patients were treated with prednisolone (PSL), according to the BSR and BHPR guidelines3), for more than 6 months. Patients treated with MTX and accompanied by the giant cell arteritis were excluded from this study. Relapse was defined as the reappearance of symptoms associated with elevated C-reactive protein (CRP) levels in patients receiving GC that required an increase in GC dose. Remission was defined as the absence of clinical symptoms and normal CRP with discontinuation of GC. We compared the clinical findings, laboratory data at baseline and clinical course between those who achieved remission within 2 years (early-remission group) and those who required GC therapy for more than 2 years (long-therapy group). Comparisons between groups were made using Student’s t-test and chi-square test (IBM SSPE statistics version 26). This study was approved by the ethics committee of Tokyo Medical University (T2019-0079).Results:As of January 2020, 89 patients have been treated with PSL for more than 6 months. 50 patients have achieved a remission, 29 were undergoing treatment, and 10 have transferred to other hospitals or died (Table 1). The median time required for the patients to achieve remission was 16 months (Interquartile Range 12-21). After one-year GC therapy, remission was achieved in 14% (11/77), 66% (41/62) after 2-year, 84% (47/56) after 3-year, and 91.0% (49/54) after 4-years. Forty-one patients, who achieved remission within 2 years, were included in the early-remission group. Twenty-one were included in the long therapy group (Table 1). There were no differences in sex, age at onset, body mass index, clinical features, and serum albumin at diagnosis. Serum CRP of long-therapy group was significantly higher than those of the early-remission group (Table 2). Mean relapse times in the full follow-up times were 0.4 in the early-remission group and 3.1 in the long-therapy group. Multivariate logistic regression analysis showed that history of relapse till 6 months was significant predictors of the long-term GC therapy (odds ratio, 6.48; 95%CI 1.44-29.12).Conclusion:The remission rates of our study are lower than those of the previous reports. We have tapered GC gradually according to the BSR and BHPR guidelines3). However, some patients need the long-term therapy for more than 2 years. We might consider additional MTX therapy in patients who experience a relapse during the first six months.References:[1]Dejaco C, et al. 2015 recommendations for the management of polymyalgia rheumatica: a European League against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2015; 74:1799-1807.[2]Dasgupta B, et al: 2012 provisional classification criteria for polymyalgia rheumatica: a European League against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis 2012;71: 484-492.[3]Dasgupta, B, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology 2010; 49:186-190.Disclosure of Interests:None declared

Rheumatoid arthritis—diagnosis

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.

A comparison and review of three sets of classification criteria for systemic lupus erythematosus for distinguishing systemic lupus erythematosus from pure mucocutaneous manifestations in the lupus disease spectrum

Lupus ◽  
2020 ◽  
Vol 29 (14) ◽  
pp. 1854-1865
Author(s):  
Hui Jin ◽  
Tao Huang ◽  
Ruifang Wu ◽  
Ming Zhao ◽  
Haijing Wu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Diagnostic Criteria ◽  
Lupus Erythematosus ◽  
Sample Selection ◽  
Cutaneous Lupus Erythematosus ◽  
Classification Criteria ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Disease Spectrum ◽  
European League Against Rheumatism

Although the original purpose of the systemic lupus erythematosus (SLE) classification criteria was to distinguish SLE from other mimic diseases, and to facilitate sample selection in scientific research, they have become widely used as diagnostic criteria in clinical situations. It is not known yet if regarding classification criteria as diagnostic criteria, what problems might be encountered? This is the first study comparing the three sets of classification criteria for SLE, the 1997 American College of Rheumatology (ACR’97), 2012 Systemic Lupus International Collaborating Clinics (SLICC’12) and 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR’19), for their ability to distinguish patients with SLE from patients with pure mucocutaneous manifestations (isolated cutaneous lupus erythematosus without internal disease, i-CLE) in the lupus disease spectrum. 1,865 patients with SLE and 232 patients with i-CLE were recruited from a multicenter study. We found that, due to low specificity, none of the three criteria are adept at distinguishing patients with SLE from patients with i-CLE. SLICC’12 performed best among the original three criteria, but if a positive ANA was removed as an entry criterion, EULAR/ACR’19 would performed better. A review of previous studies that compared the three sets of criteria was presented in this work.

scholarly journals The new 2019 American college of rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for IgG4-related disease

2020 ◽  
Vol 58 (4) ◽  
pp. 368-375
Author(s):  
E. V. Sokol
Keyword(s):  
Clinical Practice ◽  
Diagnostic Criteria ◽  
Classification Criteria ◽  
Related Disease ◽  
American College Of Rheumatology ◽  
Igg4 Related Disease ◽  
European League Against Rheumatism ◽  
Potential Use ◽  
European League

This paper considers the new 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease, discusses essential differences with IgG4-RD comprehensive diagnostic criteria (Umehara H., 2011) and comments their potential use in clinical practice. 

Consultation with rheumatologist: debut of systemic lupus erythematosus

2021 ◽  
Vol 1 (11) ◽  
pp. 55-59
Author(s):  
T. N. Gavva ◽  
A. A. Pecherskikh ◽  
D. E. Gogolev ◽  
L. V. Teplova ◽  
Yu. S. Shklyaeva ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Diagnostic Criteria ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Systemic Lupus ◽  
Clinical Criteria ◽  
American College Of Rheumatology ◽  
Rheumatological Diseases

Systemic lupus erythematosus (SLE) is one of the most complex rheumatological diseases, occurring with a variety of clinical forms and manifestations. The debuts and variants of the course of SLE can vary significantly, so it is called ‘chameleon disease’ or ‘the great imitator of diseases’. In 2019, a group of experts from the European Anti-Rheumatic League and the American College of Rheumatology developed the latest criteria for the diagnosis of systemic lupus erythematosus. A prerequisite for the diagnosis is a positive antinuclear factor in combination with the seven clinical criteria for SLE (constitutional, hematological, neuropsychiatric, skin‑mucosal, polyserositis, renal) and the three immunological signs (antiphospholipid antibodies, levels of complement and its fractions, SLE‑specific autoantibodies) The article describes a case of systemic lupus erythematosus, diagnosed in a patient who was admitted to the hospital with a directional diagnosis of ‘fever of unknown origin’. The diagnosis of systemic lupus erythematosus was established on the basis of seven clinical criteria and two immunological diagnostic criteria.

Rheumatoid arthritis—diagnosis

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.

scholarly journals Performance of 2019 EULAR/ACR Classification Criteria for Systemic Lupus Erythematosus in Children and Adults : A Retrospective Observational Study

2021 ◽  
Author(s):  
Sang Cheng ◽  
Huihua Ding ◽  
Haiyan Xue ◽  
Min Xia ◽  
Zhiqiang Tu ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
High Sensitivity ◽  
Classification Criteria ◽  
Organ Involvement ◽  
Lower Sensitivity ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Major Organ ◽  
Increased Sensitivity

Abstract Background: The European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) recently developed a systemic lupus erythematosus (SLE) classification criteria (EULAR/ACR-2019) with high sensitivity and specificity. The aim of this study was to validate and compare the performance of the newly developed criteria to that of the ACR-1997 and the 2012 Systemic Lupus International Collaborating Clinics (SLICC-2012) criteria in juvenile-onset SLE (jSLE) and adult-onset SLE (aSLE) patients.Methods: We conducted a retrospective study of SLE patients (221 children and adult) and controls (214 children and adult) with defined rheumatic diseases to establish the ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria. The performance of the three criteria was statistically analyzed.Results: For jSLE, sensitivities of ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria were 63.3%, 94.6% and 98.2% (P < 0.001), with specificities 99.5%, 98.6% and 93.5% (P < 0.001), respectively. For aSLE, sensitivities of ACR-1997, SLICC-2012 and EULAR/ACR-2019 criteria were 72.9%, 96.8% and 99.1% (P < 0.001), with specificities 97.2%, 92.5% and 90.2% (P = 0.013), respectively. In ANA positive juvenile patients, a EULAR/ACR score ≥13 instead of a score ≥10 resulted in higher specificity (93.1% vs. 75.9%), despite slightly lower sensitivity (92.2% vs. 99.5%). In both jSLE and aSLE patients, the SLICC-2012 and EULAR/ACR-2019 criteria had increased sensitivity for major organ involvement than ACR-1997.Conclusion: The EULAR/ACR-2019 criteria showed similar sensitivity to jSLE and aSLE patients and was more sensitive than ACR-1997 and SLICC-2012 criteria, allowing earlier recognition of patients with single or major organ involvement. The adoption of a EULAR/ACR total score ≥13 in this study, instead of the initially proposed ≥10 score, was more appropriate to classify jSLE.

scholarly journals THU0480 EXPERIENCE USING DIFFERENT CRITERIA OF FIBROMYALGIA IN PATIENTS WITH ANKYLOSING SPONDYLITIS: 1990 AMERICAN COLLEGE OF RHEUMATOLOGY CLASSIFICATION CRITERIA VS. NEW

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 477.1-478
Author(s):  
I. Shapoval ◽  
M. Stanislavchuk ◽  
H. Movchan
Keyword(s):  
Ankylosing Spondylitis ◽  
Diagnostic Criteria ◽  
Inflammatory Arthritis ◽  
Information Needs ◽  
Correct Diagnosis ◽  
Pain Syndrome ◽  
Classification Criteria ◽  
American College Of Rheumatology ◽  
Study Results ◽  
New Criteria

Background:Fibromyalgia (FM) is a very frequent condition in patients with diseases associated with pain syndrome, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and other chronic rheumatic diseases. FM, RA and AS has different clinical characteristics, but can share symptoms such as pain, fatigue and sleep disturbance that leads to delay in appropriation correct diagnosis [1]. For today well known many different criteria for FM: 1990 American College of Rheumatology (ACR) classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and new AAPT Diagnostic Criteria for Fibromyalgia. According to the literature, prevalence FM in AS patients can reach from 12.6 to 28.5%, but prevalence estimates should be interpreted with care as no data that the criteria for FM have been validated for use in patients with AS and other chronic inflammatory arthritis [1, 2]. The lack of appropriate information needs further investigation for better identification FM.Objectives:The aim of our study was to compare the presence of FM by 1990 ACR classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and new criteria FM 2019 - AAPT Diagnostic Criteria for Fibromyalgia in AS patients.Methods:One hundred and thirteen AS patients (19 women and 94 men) with mean age (M ± SD) 42.3±10.94 years were enrolled in the study. Diagnosis AS was established according to modified New York criteria. For FM detection were used 1990 ACR classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and AAPT Diagnostic Criteria for Fibromyalgia. All patients were asked to complete self-reported disease-related questionnaires for patients with AS.Results:According 1990 ACR criteria, FM met in 26 patients (23%). 38.1% patients were positively screened for FM due to modified 2010 ACR diagnostic criteria, and in 31.9% patients according 2016 Fibromyalgia Diagnostic Criteria, and in 41.6% patients due to AAPT Diagnostic Criteria for Fibromyalgia. All new criteria correlated with 1990 ACR classification criteria with p<0,01: r=0.654, r=0.664, r=0.520, concordantly. Using the ROC analysis, we evaluated the sensitivity and specificity of different FM criteria in patients with AS. Our results showed high diagnostic value of all new criteria, but the most sensitive for detection FM in patients with AS were the modified 2010 ACR diagnostic criteria with sensitivity of 96% and specificity of 79%.Conclusion:Our study results confirmed very high prevalence FM in patients with AS.The most sensitive tool for detection FM in patients with AS were the modified 2010 ACR diagnostic criteria with sensitivity of 96% and specificity of 79%.The similar percentages of FM due to different classification criteria might be a good sign in context of the validity of these criteria for AS patient.References:[1]Zhao, S. S., Duffield, S. J., & Goodson, N. J. (2019). The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis.Best Practice & Research Clinical Rheumatology, 1014-23.[2]Salaffi, F., De Angelis, R., Carotti, M., Gutierrez, M., Sarzi-Puttini, P., & Atzeni, F. (2014). Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity.Rheumatology international,34(8), 1103-1110.Disclosure of Interests: :None declared

scholarly journals Anti-beta 2 glycoprotein I IgA in the SLICC classification criteria dataset

Lupus ◽  
2021 ◽  
pp. 096120332110142
Author(s):  
Marwa Elkhalifa ◽  
Ana-Maria Orbai ◽  
Laurence S Magder ◽  
Michelle Petri ◽  
Graciela S Alarcón ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
African Descent ◽  
Clinical Manifestations ◽  
Classification Criteria ◽  
The Other ◽  
Clinical Criteria ◽  
American College Of Rheumatology ◽  
Glycoprotein I ◽  
Beta 2 ◽  
The Difference

Objective Anti-beta 2 glycoprotein I IgA is a common isotype of anti-beta 2 glycoprotein I in SLE. Anti-beta 2 glycoprotein I was not included in the American College of Rheumatology (ACR) SLE classification criteria, but was included in the Systemic Lupus International Collaborating Clinics (SLICC) criteria. We aimed to evaluate the prevalence of anti-beta 2-glycoprotein I IgA in SLE versus other rheumatic diseases. In addition, we examined the association between anti-beta 2 glycoprotein I IgA and disease manifestations in SLE. Methods The dataset consisted of 1384 patients, 657 with a consensus physician diagnosis of SLE and 727 controls with other rheumatic diseases. Anti-beta 2 glycoprotein I isotypes were measured by ELISA. Patients with a consensus diagnosis of SLE were compared to controls with respect to presence of anti-beta 2 glycoprotein I. Among patients with SLE, we assessed the association between anti-beta 2 glycoprotein I IgA and clinical manifestations. Results The prevalence of anti-beta 2 glycoprotein I IgA was 14% in SLE patients and 7% in rheumatic disease controls (odds ratio, OR 2.3, 95% CI: 1.6, 3.3). It was more common in SLE patients who were younger patients and of African descent (p = 0.019). Eleven percent of SLE patients had anti-beta 2 glycoprotein I IgA alone (no anti-beta 2 glycoprotein I IgG or IgM). There was a significant association between anti-beta 2 glycoprotein I IgA and anti-dsDNA (p = 0.001) and the other antiphospholipid antibodies (p = 0.0004). There was no significant correlation of anti-beta 2 glycoprotein I IgA with any of the other ACR or SLICC clinical criteria for SLE. Those with anti-beta 2 glycoprotein I IgA tended to have a history of thrombosis (12% vs 6%, p = 0.071), but the difference was not statistically significant. Conclusion We found the anti-beta 2 glycoprotein I IgA isotype to be more common in patients with SLE and in particular, with African descent. It could occur alone without other isotypes.

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