Comparison of the 1987 ACR and 2010 ACR/EULAR classification criteria for rheumatoid arthritis in clinical practice: a prospective cohort study
Comparison of the 1987 ACR and 2010 ACR/EULAR classification criteria for rheumatoid arthritis in clinical practice: a prospective cohort study
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DOI：
10.3109/03009742.2013.776103
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Dahlqvist, S. R.
中科院分区：
文献类型：
--
作者：
Berglin, E.;Dahlqvist, S. R.
目的：比较1987年美国风湿病学会（ACR）和2010年ACR/欧洲抗风湿联盟（EULAR）分类标准在类风湿关节炎（RA）诊断中的应用。连续纳入至少一个关节有滑膜炎、除RA外没有更好地解释滑膜炎的诊断、首次访视时症状持续时间小于1年且随访至少1年的患者。对基线时1987年和2010年标准的履行情况进行了评价。每个标准集的敏感性和特异性，通过使用结局指标进行估计：第一年开始甲氨蝶呤（MTX）治疗，1年随访时临床诊断为RA。使用Larsen score.Results：该研究包括313例患者，其中56%符合1987年ACR标准，74%符合2010年ACR/EULAR标准，53%符合基线两组标准。1987年和2010年标准的敏感性/特异性分别为0.68/0.79和0.84/0.54，第一年内MTX作为结局指标，随访时诊断为RA分别为0.72/0.83和0.91/0.65。老年患者（即>= 60岁）更常符合2010年标准。符合2010年ACR/EULAR标准但不符合1987年ACR标准的患者在入选时和2年后的Larsen评分较低。结论：与1987年ACR标准相比，2010年ACR/EULAR标准具有较高的敏感性，但特异性较低，尤其是在年龄≥ 60岁的患者中。建议采用1987年ACR标准预测糜烂性疾病。
Objective: To compare application of the 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) classification criteria for diagnosing rheumatoid arthritis (RA) in clinical practice.Method: The medical records of patients with early arthritis attending the Rheumatology Department, Umea University Hospital (n = 1026) were analysed. Patients with synovitis in at least one joint, no diagnosis other than RA being better for explaining the synovitis, and duration of symptoms less than 1 year at first visit, and at least 1 year of follow-up were included consecutively. Fulfilment of the 1987 and 2010 criteria at baseline was evaluated. Sensitivity and specificity for each criterion set, where estimated by using the outcome measures: initiation of methotrexate (MTX) therapy during the first year, and a clinical diagnosis of RA at the 1-year follow-up. Radiographs of hands and feet were evaluated using the Larsen score.Results: The study included 313 patients, of whom 56% fulfilled the 1987 ACR criteria, 74% the 2010 ACR/EULAR criteria, and 53% both sets of criteria at baseline. The sensitivity/specificity for the 1987 and 2010 criteria with MTX within the first year as the outcome measure was 0.68/0.79 and 0.84/0.54, respectively, and with a diagnosis of RA at follow-up 0.72/0.83 and 0.91/0.65, respectively. Older patients (i.e. >= 60 years) more often fulfilled the 2010 criteria. Patients who fulfilled the 2010 ACR/EULAR but not the 1987 ACR criteria had a lower Larsen score at inclusion and after 2 years.Conclusions: Compared with the 1987 ACR criteria, the 2010 ACR/EULAR criteria have higher sensitivity but lower specificity, especially in patients aged >= 60 years. The 1987 ACR criteria are suggested to predict a more erosive disease.