Deane Kevin D, Striebich Christopher C, Goldstein Barbara L, Derber Lezlie A, Parish Mark C, Feser Marie L, Hamburger Elaine M, Brake Stacey, Belz Cindy, Goddard James, Norris Jill M, Karlson Elizabeth W, Holers V Michael
University of Colorado Denver, Aurora, CO, USA.
Arthritis Rheum. 2009 Dec 15;61(12):1642-9. doi: 10.1002/art.24834.
To identify individuals with undiagnosed inflammatory arthritis (IA) and rheumatoid arthritis (RA) in a community health fair screen, and to establish in a health fair setting the diagnostic accuracy of combinations of the Connective Tissue Disease Screening Questionnaire (CSQ) and autoantibody testing for IA.
Screening for IA/RA was performed at health fair sites using a combination of the CSQ, joint examination, rheumatoid factor, and anti-cyclic citrullinated peptide (anti-CCP) antibody testing. IA was defined as > or =1 swollen joint suggestive of synovitis on joint examination by a trained clinician.
Six hundred one subjects were screened; 51.0% participated because of joint symptoms (pain, stiffness, or swelling). Eighty-four subjects (14.0%) had > or =1 swollen joint, designated as IA on joint examination. Of the 601 subjects screened, 9 (1.5%) had IA and met > or =4 of 7 American College of Rheumatology criteria for RA but had no prior diagnosis of RA, and 15 (2.5%) had IA and RF and/or anti-CCP positivity, suggesting early RA. The diagnostic accuracy of combinations of the CSQ and autoantibody testing for the identification of IA yielded maximal sensitivity, specificity, and positive and negative predictive values of 95.3%, 99.2%, 71.4%, and 97.7%, respectively.
Health fair screening may be an effective approach for the identification of individuals with undiagnosed IA/RA. A combination of the CSQ and autoantibody testing alone has clinically useful diagnostic accuracy for the detection of IA. Decisions regarding which methodology to use for future health fair IA/RA screening will depend on goals of screening and funding.
在社区健康博览会筛查中识别未确诊的炎性关节炎（IA）和类风湿关节炎（RA）患者，并在健康博览会环境中确定结缔组织病筛查问卷（CSQ）与自身抗体检测相结合对IA的诊断准确性。
在健康博览会现场，采用CSQ、关节检查、类风湿因子和抗环瓜氨酸肽（抗CCP）抗体检测相结合的方法筛查IA/RA。IA定义为经训练有素的临床医生关节检查发现≥1个提示滑膜炎的肿胀关节。
共筛查601名受试者；51.0%因关节症状（疼痛、僵硬或肿胀）参与筛查。84名受试者（14.0%）有≥1个肿胀关节，关节检查时被定为IA。在601名筛查受试者中，9名（1.5%）患有IA且符合美国风湿病学会7项RA标准中的≥4项，但之前未被诊断为RA，15名（2.5%）患有IA且类风湿因子和/或抗CCP呈阳性，提示早期RA。CSQ与自身抗体检测相结合对IA的诊断准确性产生的最大敏感性、特异性、阳性和阴性预测值分别为95.3%、99.2%、71.4%和97.7%。
健康博览会筛查可能是识别未确诊IA/RA患者的有效方法。单独使用CSQ和自身抗体检测相结合对IA的检测具有临床有用的诊断准确性。关于未来健康博览会IA/RA筛查使用哪种方法的决策将取决于筛查目标和资金情况。
