ABILITY OF AMERICAN COLLEGE OF RHEUMATOLOGY 1987 CRITERIA TO PREDICT RHEUMATOID ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW

Background: To date, no definite diagnostic tool is available to predict the further appearance of rheumatoid arthritis (RA) when faced with a patient presenting with early arthritis. In 1988, Arnett et al. proposed the American Rheumatism Association 1987 revised criteria for classification of RA, but its use as a diagnostic tool is not established. Furthermore 2 different forms of these criteria (list or tree criteria) have been proposed.Objectives: To evaluate the ability of the American College of Rheumatology 1987 criteria to predict RA in unclassified early arthritis and in established arthritis.Methods: A systematic analysis of the literature published between 1988 and December 2006 was conducted. All articles reporting the prevalence of ACR criteria in cohorts of early or established arthritis were analyzed. Data were collected to calculate the sensitivity and specificity of ACR 1987 criteria in early arthritis (less than one year) and established arthritis (over one year). Gold standard for diagnosis of RA was based on an expert diagnosis (one or more rheumatologists).Results: Among the 64 publications initially identified, 16 had interpretable data and were analyzed. The total number of patients included in all the analysed studies was 6868. The total number of RA patients was 3352 (controls i.e. non-RA patients: 3516). In early arthritis, sensitivity and specificity of ACR list criteria were respectively of 67 and 75%. For ACR tree criteria, sensitivity and specificity were respectively of 72 and 35%. In established arthritis, sensitivity and specificity for list criteria were respectively of 75 and 92 and for tree criteria, of 81 and 96%.Conclusion: This study confirm that sensitivity and specificity of ACR 1987 criteria in early RA are low, and that these criteria could not be used as diagnostic tools. However, sensitivity and specificity in established RA is higher, which reflects their use as classification criteria gold standard.References: 1. Pederson M et al. Eur J Epidemiol 2004; 19: 1097-103.2. Saraux A et al. Arthritis Rheum 2001; 44: 2485-91.3. Hulsemann JL et al. Ann Rheum Dis 1999; 58: 278-80.4. Harrison BJ et al. J Rheumatol 1998; 25: 2324-30.5. Levin RW et al. Scand J Rheumatol 1997; 25: 277-81.6. Chogle AR et al. J Assoc Physicians India 1996; 44: 93-7.7. Leitich H et al. Methods Inf Med 1996; 35: 334-42.8. Kaarela K et al. Scand J Rheumatol 1995; 24: 279-81.9. MacGregor AJ et al. J Rheumatol 1994; 21: 1420-6.10. Jacobsson LT et al. Arthritis Rheum 1994; 37: 1479-86.11. Hakala M et al. J Rheumatol 1993; 20: 1674-8.12. Bernelot Moens HJ et al. J Rheumatol 1992; 19: 198-203.13. Yang JL et al. Chin Med J (Engl) 1991; 104: 649-52.14. Rigby AS et al. Scand J Rheumatol 1990; 19: 27-41.15. Dugowson CE et al. Arthritis Rheum 1990; 33: 1042-6.16. Arnett FC et al. Arthritis Rheum 1988; 31: 315-24.Citation: Ann Rheum Dis, volume 66, supplement II, year 2007, page 320Session: RA – epidemiology, prognosis and predictors