Luo C N, Li Z F, Wu L J, Chen H J, Yang C M, Xu W H, Liu X L, Tang W, Qiao P, Rena B
Department of Rheumatology and Immunology, People's Hospital of Xinjiang Ugyur Autonomous Region, Urumuqi 830001, China.
Department of Rheumatology and Immunology, People's Hospital of Changji, Changji 831100, Xinjiang, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Oct 18;52(5):897-901. doi: 10.19723/j.issn.1671-167X.2020.05.017.
To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR).
Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features.
(1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (=43.641, < 0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (=0.446, =0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (=4.891, =0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (=0.044, =1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (=7.131, =0.008; =22.015, < 0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (=0.220, =0.755; =0.473, =0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836).
The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.
评估早期类风湿关节炎（ERA）的分类标准，并将其敏感性和特异性与1987年美国风湿病学会（ACR）标准及2010年ACR/欧洲抗风湿病联盟（EULAR）标准进行比较。
纳入来自4家医院、年龄大于16岁、患有关节炎、病程≤1年且有≥1个关节疼痛和肿胀的患者。观察包括临床表现、实验室检查及影像学检查等指标。ERA患者由两名经验丰富的风湿病学家根据临床特征、药物治疗信息及放射学特征进行诊断。
（1）共纳入325例关节炎患者，其中男性98例（30.15%），女性227例（69.85%），平均年龄为（47.53±14.44）岁，疾病持续时间中位数为5（2，8）个月。最终，236例患者被诊断为ERA，89例患者被诊断为其他疾病（非ERA，包括骨关节炎、反应性关节炎、未分化关节炎、脊柱关节炎等）。（2）ERA标准的敏感性为87.29%，特异性为84.37%。其敏感性高于1987年ACR标准（χ²=43.641，P<0.001），与2010年ACR/EULAR标准相比无显著差异（χ²=0.446，P=0.593）。但ERA标准的特异性低于1987年ACR标准（χ²=4.891，P=0.027），与2010年ACR/EULAR标准相比无统计学意义（χ²=0.044，P=1.000）。（3）在病程≤3个月和≤6个月的关节炎患者中，ERA标准的敏感性分别为81.71%和86.79%，均高于1987年ACR标准（χ²=7.131，P=0.008；χ²=22.015，P<0.001），与2010年ACR/EULAR标准相比无统计学差异（χ²=0.220，P=0.755；χ²=0.473，P=0.491）。三种标准在特异性方面的差异无统计学意义。（4）三种不同分类标准与临床诊断一致，其中ERA标准和2010年ACR/EULAR标准一致性稍高（Kappa>0.6）。三种标准之间一致性比较结果显示，ERA标准与2010年ACR/EULAR标准一致性较好（Kappa=0.836）。
ERA分类标准诊断ERA的敏感性高于1987年ACR标准，与2010年ACR/EULAR标准相当。这三种标准在特异性方面无显著差异。ERA标准还可在病程≤3个月的关节炎极早期识别出类风湿关节炎患者。
