Document Detail


Very recent onset arthritis: the value of initial rheumatologist evaluation and anti-cyclic citrullinated peptide antibodies in the diagnosis of rheumatoid arthritis.
MedLine Citation:
PMID:  19504230     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (<or=12 weeks) referred by primary care physicians were assessed by a designated rheumatologist who predicted in those with >or=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 >or=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.
Authors:
Jorge Rojas-Serrano; Rub??n Burgos-Vargas; Leticia Lino P??rez; Conrado Garc??a Garc??a; Francisco Moctezuma; Janitzia V??zquez-Mellado
Publication Detail:
Type:  Journal Article     Date:  2009-06-07
Journal Detail:
Title:  Clinical rheumatology     Volume:  28     ISSN:  1434-9949     ISO Abbreviation:  Clin. Rheumatol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-03     Completed Date:  2010-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8211469     Medline TA:  Clin Rheumatol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1135-9     Citation Subset:  IM    
Affiliation:
Instituto Nacional de Enfermedades Respiratorias, Ismael Cos??o Villegas, Universidad Nacional Aut??noma de M??xico, Faculty of Medicine, Mexico City, Mexico. jrojas@iner.gob.mx
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibodies, Anti-Idiotypic / blood*,  immunology
Arthritis, Rheumatoid / blood,  diagnosis*,  immunology*
Biological Markers / blood
Cohort Studies
Disability Evaluation*
Female
Follow-Up Studies
Humans
Joints / pathology,  physiopathology
Male
Middle Aged
Peptides, Cyclic / immunology*
Predictive Value of Tests
Regression Analysis
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Antibodies, Anti-Idiotypic; 0/Biological Markers; 0/Peptides, Cyclic; 0/cyclic citrullinated peptide

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