%0 Journal Article
%T Validation of a Prediction Rule for the Diagnosis of Rheumatoid Arthritis in Patients with Recent Onset Undifferentiated Arthritis
%A Zaida Bedran
%A Cristian Quiroz
%A Javier Rosa
%A Luis J. Catoggio
%A Enrique R. Soriano
%J International Journal of Rheumatology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/548502
%X Objectives. To validate van der Helm-van Mil score (vHvM) and new ACR/EULAR criteria for the diagnosis of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA). Patients and Methods. Adult patients with UA (swelling ¡Ý2 joints of less than 6 months duration, without diagnosis, and never treated with disease modifying drugs). Results. Ninety-one patients were included. Mean age: 55.6 years (SD: 17.4), 74% females. Median symptoms duration was 2 months (IR: 1¨C4 months). Mean van der Helm-van Mil score was 6.9 (SD: 2). After a mean followup of 6.2 months (SD: 6), 40.7% patients fulfilled ACR 1987 RA classification criteria, 28.6% fulfilled other diagnostic criteria, and 31% remained as UA. Receiver operator characteristic curve's (ROC's) area under the curve (AUC) for the vHvM score for diagnosis of RA was 0.83. A cutoff value of 6.94 showed sensitivity of 81% and 79.7% specificity. For the new ACR/EULAR criteria, the ROC AUC was 0.93, and a value equal to or greater than 6 showed 86.5% sensitivity and 87% specificity. Conclusion. van der Helm-van Mil prediction score and the new ACR/EULAR criteria proved to be valuable for the diagnosis of RA in patients with early UA. 1. Introduction Rheumatoid arthritis (RA) is a systemic disease characterized by chronic inflammation that often leads to joint destruction. A greater awareness of RA [1, 2] has led to new efforts in order to establish a definitive diagnosis as early as possible after onset of symptoms [1¨C4]. Identifying patients with early arthritis at risk of developing persistent and/or erosive arthritis is mandatory for selecting a treatment strategy, according to the current early aggressive treatment approach [4]. The American College of Rheumatology (ACR) 1987 [5] classification criteria for RA were developed for clinical trials and research purposes, and it is not an appropriate tool for applying in the very early phase of the disease, mainly because of low sensitivity [6]. On the other hand, the majority of patients who present with recent onset arthritis have undifferentiated arthritis (UA) which is a form of arthritis that does not fulfill the classification criteria for a more definitive diagnosis. It is known that around 40%¨C50% of them may experience spontaneous remission, whereas RA develops in one-third of patients with UA [7, 8]. Therefore, finding predictors of the disease to take individualized decisions regarding treatment is one of the most important challenges in RA. According to the UA evolution mentioned previously, we believe that the consequences of over- or
%U http://www.hindawi.com/journals/ijr/2013/548502/