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Evaluation of Clinical Measures and Different Criteria for Diagnosis of Adult-onset Still's Disease in a Chinese Population.
MedLine Citation:
PMID:  21285163     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To determine the value of clinical measures in diagnosis of adult-onset Still's disease (AOSD), and to identify the optimal set of proposed classification criteria, in a Chinese population. METHODS: A total of 70 patients with AOSD and 140 non-AOSD inpatients with fever were retrospectively identified at Zhongshan Hospital, Shanghai, from January 2003 to December 2009. Clinical measures and 4 sets of diagnostic criteria (Yamaguchi, Calabro, Cush, and Reginato) were evaluated by sensitivity, specificity, positive/negative predictive value (PPV, NPV), and positive/negative likelihood ratio (PLR, NLR) for diagnosis of AOSD. RESULTS: In our series, higher sensitivity included hyperpyrexia (temperature ≥ 39°C, 94.29%), arthralgia (80.0%), polymorphonuclear neutrophils (PMN) ≥ 75% (84.29%), serum ferritin ≥ 2-fold the upper normal value (90.0%), negative antinuclear antibodies (85.29%), and rheumatoid factor (84.38%); while higher specificity included transient erythema (98.57%), sore throat (85.0%), leukocytes ≥ 15,000/mm3 (87.86%), and PMN ≥ 85% (85.0%). Rash, arthralgia, and sore throat were found to have better sensitivity and specificity (PLR 3.29-4.86). Leukocytes ≥ 10,000/mm3, PMN ≥ 80%, and serum ferritin ≥ 5-fold the upper normal limit were set as critical points. The Reginato criteria set had the highest specificity, 99.29%. The Yamaguchi set had the highest sensitivity, 78.57%, with a better accuracy of 87.14%. CONCLUSION: The Yamaguchi diagnostic criteria had better accuracy in Chinese patients. Indicators such as rash, arthralgia, sore throat, leukocytes ≥ 10,000/mm3, PMN ≥ 80%, and serum ferritin ≥ 5-fold the upper normal limit were helpful for diagnosis of AOSD. We recommend using these indicators in combination instead of alone.
Lindi Jiang; Zhen Wang; Xiaomin Dai; Xuejuan Jin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-1
Journal Detail:
Title:  The Journal of rheumatology     Volume:  -     ISSN:  0315-162X     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Department of Rheumatology, Zhongshan Hospital, Fudan University; and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
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