Karateev D E, Luchikhina E L, Tiurina L N, Chemeris N A, Pogozheva E Iu, Lukina G V, Potanin A Iu, Shostak N A, Kogan K M, Demidova N V, Kasumova K A, Pozdniakova E S, Fedorenko E V, Aleksandrova E N, Novikov A A, Smirnov A V, Nasonov E L
Ter Arkh. 2008;80(5):8-13.
To estimate potentialities of early diagnosis of rheumatoid arthritis (RA) diagnosis in clinical practice in the course of the RADICAL program.
Of 366 patients participating in the trial 61 (16.7%) were males and 305 (83.3%) were females at the age of 47.76 +/- 14.1 years. The longest duration of the symptoms before consulting a doctor was 51 weeks, mean duration--5.7 weeks, 55% patients had the symptoms for 3 weeks. All the patients have undergone laboratory examination including leukocyte count, platelet count, estimation of ESR, concentration of C-reactive protein (CRP), rheumatoid factor (RF) and antibodies to a cyclic citrullated peptide (ACCP); roentgenography of the wrists and feet. On demand, antinuclear factor (ANF) and HLA-B27 were investigated. RA was diagnosed on the basis of ACR classification criteria. If the criteria were not complete at the moment of the study, the patient was referred to the group of "undifferentiated arthritis" (UA). The patients were examined before the treatment, 6 and 12 months later. The treatment was made according to Russian clinical recommendations.
Prior to admission to hospital, 58% patients were suspected for RA, 18.3%--osteoarthrosis (OA), 14%--reactive arthritis. 18.9% were not diagnosed, other diagnoses were considered in 12.6% patients. At primary examination RA was diagnosed in 212 (57.9%) patients, UA was in 133 (36.3%) patients, 21 (5.7%) patients had other diagnoses. Twelve months later RA, UA and other diseases were diagnosed in 256 (69.9%), 70 (19.1%) and 40 (10.9%) patients, respectively.
A 3-stage algorithm of early RA diagnosis is proposed. At the stage of the first contact with the patient in an outpatient clinic a valid RA suspition with consideration of modified EULAR criteria must be formulated. At the second stage a district rheumatologist must examine the patient outpatiently with determination of ACR classification criteria. In diagnosis verification the treatment must be started according to APP and EULAR clinical recommendations. If RA diagnosis can not be verified or rejected, the patient must be refered to hospital (stage 3). If verification of RA diagnosis is impossible, the diagnosis should be formulated as UA.
评估在“根治”项目过程中类风湿关节炎（RA）在临床实践中的早期诊断潜力。
参与试验的366例患者中，男性61例（16.7%），女性305例（83.3%），年龄47.76±14.1岁。就诊前症状持续时间最长为51周，平均持续时间为5.7周，55%的患者症状持续3周。所有患者均接受了实验室检查，包括白细胞计数、血小板计数、血沉（ESR）评估、C反应蛋白（CRP）浓度、类风湿因子（RF）及抗环瓜氨酸肽抗体（ACCP）检测；手腕和足部的X线检查。根据需要，检测抗核因子（ANF）和HLA - B27。RA根据美国风湿病学会（ACR）分类标准进行诊断。如果在研究时标准不完整，患者被归入“未分化关节炎”（UA）组。在治疗前、治疗6个月和12个月后对患者进行检查。治疗按照俄罗斯临床建议进行。
入院前，58%的患者被怀疑患有RA，18.3%被怀疑患有骨关节炎（OA），14%被怀疑患有反应性关节炎。18.9%未明确诊断，12.
