Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Rheumatol Int. 2014 Mar;34(3):407-11. doi: 10.1007/s00296-013-2865-2. Epub 2013 Sep 24.
Performance of rheumatoid arthritis (RA) classification by the 2010 American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) criteria, compared to the 1987 ACR criteria, has not been assessed in population-based cohorts in which disease identification is by mailed questionnaire. Women followed in the Nurses' Health Study and Nurses' Health Study II cohorts self-reported new doctor-diagnosed RA on biennial questionnaires. Two RA experts reviewed medical records of 128 new RA self-reports to obtain individual 1987 and 2010 criteria and arrived at a consensus opinion. We compared agreement in classification by the two criteria sets (kappa), and calculated sensitivity and specificity, with reviewers' opinion as gold standard. Ninety-eight (77%) participants were classified as RA by reviewers' consensus opinion; 98 (77%) fulfilled 1987 criteria, while 79 (63%) fulfilled 2010 criteria. Seventy-two (56%) were classified as RA by both sets, 21 (16%) by neither, 26 (20%) by only 1987 criteria, and 9 (7%) by only 2010 criteria. Kappa for concordance was 0.36 (95% CI 0.20-0.53). Compared to reviewer's opinion, sensitivity and specificity were 0.93 and 0.77 for 1987 criteria, and 0.79 and 0.87 for 2010 criteria. Participants fulfilling 1987 criteria only were more likely to be seronegative. In these prospective population-based cohorts, significant discordance between 1987 ACR and 2010 ACR/EULAR criteria for classifying RA exists. Using the 2010 ACR/EULAR criteria alone had decreased sensitivity, and seronegative RA cases would be excluded in particular. Combined use of both will be necessary to maximize inclusion and allow sensitivity analyses.
2010 年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）标准对类风湿关节炎（RA）的分类性能，与 1987 年 ACR 标准相比，尚未在通过邮寄问卷进行疾病识别的基于人群的队列中进行评估。参加护士健康研究和护士健康研究 II 队列的女性每两年通过问卷自我报告新确诊的 RA。两位 RA 专家审查了 128 例新 RA 自我报告的医疗记录，以获得个体 1987 年和 2010 年标准，并达成共识意见。我们比较了两种标准集的分类一致性（kappa），并计算了敏感性和特异性，以审查员的意见为金标准。98 名（77%）参与者经审查员的共识意见被归类为 RA；98 名（77%）符合 1987 年标准，而 79 名（63%）符合 2010 年标准。72 名（56%）被两种标准集均归类为 RA，21 名（16%）两种标准集均未归类，26 名（20%）仅符合 1987 年标准，9 名（7%）仅符合 2010 年标准。一致性的 kappa 值为 0.36（95%CI 0.20-0.53）。与审查员的意见相比，1987 年标准的敏感性和特异性分别为 0.93 和 0.77，2010 年标准分别为 0.79 和 0.87。仅符合 1987 年标准的参与者更有可能为血清阴性。在这些前瞻性基于人群的队列中，1987 年 ACR 和 2010 年 ACR/EULAR 标准在 RA 分类方面存在显著差异。单独使用 2010 年 ACR/EULAR 标准会降低敏感性，特别是会排除血清阴性的 RA 病例。因此，有必要同时使用两种标准，以最大限度地纳入病例，并进行敏感性分析。
