Very recent onset arthritis: the value of initial rheumatologist evaluation and anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis
Very recent onset arthritis: the value of initial rheumatologist evaluation and anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis
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DOI：
10.1007/s10067-009-1206-z
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发表时间：
2009-06
影响因子：
3.4
通讯作者：
J. Rojas-Serrano;R. Burgos-Vargas;Leticia Lino Pérez;C. García García-C.-García-García-49141962;Francisco Moctezuma;J. Vázquez-Mellado
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文献类型：
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作者：
J. Rojas-Serrano;R. Burgos-Vargas;Leticia Lino Pérez;C. García García-C.-García-García-49141962;Francisco Moctezuma;J. Vázquez-Mellado
本研究的目的是在一组新近发病的关节炎患者的1年随访结束时，确定与类风湿性关节炎（RA）诊断相关的基线因素。由初级保健医生转诊的自述关节炎（≤12周）的事件病例由指定的风湿病专家评估，该专家在随访结束时预测关节肿胀≥1的患者诊断为RA。对诊断预测一无所知的风湿病学家定期对患者进行随访和诊断。在119例转诊患者中，78例（65.5%；年龄35.5±13.5岁；69例女性）在基线时被诊断为近期发病的关节炎（中位病程6周（0-12周））；完成1年随访的75例患者中，51例（66.5%）归类为RA；12例（16%）患有自限性关节炎；其他诊断13例（17.5%）。最终诊断为RA的患者特征为多关节炎，晨僵≥1小时，关节肿胀计数高，全身性症状发生率低。在logistic回归分析中，风湿病学家对RA和抗环瓜氨酸肽（anti-CCP）抗体的预测与RA的最终诊断密切相关。风湿病学家预测的敏感性和特异性分别为94%和74%，抗ccp抗体的敏感性和特异性分别为56%和96%；这两个变量的组合特异性为100%，敏感性为53%，阳性预测值为98%。风湿病学家预测的RA诊断和抗ccp抗体的结合对非常早期关节炎患者的RA诊断具有高度特异性。
The objective of this study is to identify baseline factors associated with rheumatoid arthritis (RA) diagnosis at the end of 1-year follow-up in a cohort of patients with very recent onset arthritis. Incident cases with self-reported arthritis (≤12 weeks) referred by primary care physicians were assessed by a designated rheumatologist who predicted in those with ≥1 swollen joint the diagnosis of RA at the end of follow-up. Patients were regularly seen and diagnosed through follow-up by staff rheumatologists who were blind to diagnostic prediction. Of 119 referrals, 78 (65.5%; age 35.5 ± 13.5 years; 69 females) were diagnosed at baseline as very recent onset arthritis (median duration 6 weeks (0–12 weeks)); of 75 patients completing 1-year follow-up, 51 (66.5%) were classified as RA; 12 (16%) had self-limited arthritis; and 13 (17.5%) other diagnoses. The characteristics of patients with RA as final diagnosis were polyarthritis, morning stiffness ≥1 h, high counts of swollen joints, and low frequency of systemic symptoms. Rheumatologist prediction of RA and anti-cyclic citrullinated peptide (anti-CCP) antibodies was strongly associated with RA as a final diagnosis in the logistic regression analysis. Sensitivity and specificity of the rheumatologist prediction were 94% and 74%, for anti-CCP antibodies, 56% and 96%; the combination of both variables had a specificity of 100% and a sensitivity of 53%, and a positive predictive value of 98%. The combination of RA as predicted diagnosis by a rheumatologist and anti-CCP antibodies is highly specific for RA diagnosis in patients with very early arthritis.