Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.
Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium.
Autoimmun Rev. 2024 Jan;23(1):103421. doi: 10.1016/j.autrev.2023.103421. Epub 2023 Aug 24.
Current classification criteria for rheumatoid arthritis (RA) encompass clinical and immunological items and are capable of correctly identifying the majority of symptomatic RA patients. The presence of positive rheumatoid factor (RF) and/or and anti-cyclic citrullinated protein/peptide antibodies (ACPA) gaining increasing importance according to their serological titer eases the recognition of RA, yet the debate is open on whether this scoring system ought to be optimized by hierarchizing ACPA or the combination of ACPA and RF over single positivity, prioritizing specificity over sensitivity. The risk of misdiagnosis and misclassification are often entangled, yet they are not the same. In fact, while ideal diagnosis requires 100% sensitivity and specificity, classification criteria are conceived to gather a homogeneous patient population, favoring specificity over sensitivity. Nevertheless, as they are frequently summoned to support the diagnostic process in clinical practice, issues arise on how comprehensive those should be and on how frequently they should be updated in light of novel acquisitions regarding measurable RA-related abnormalities. In this viewpoint two different views on the topic are confronted, discussing the performance of available criteria and the potentiality and pitfalls of their refinement according to novel data on ACPA and RF contribution and emergence of newly discovered specificities.
目前的类风湿关节炎（RA）分类标准包含临床和免疫学项目，能够正确识别大多数有症状的 RA 患者。根据其血清滴度，阳性类风湿因子（RF）和/或抗环瓜氨酸肽/肽抗体（ACPA）的存在变得越来越重要，这有助于识别 RA，但关于是否应该通过将 ACPA 或 ACPA 与 RF 的组合优先于单一阳性进行分层，将特异性置于敏感性之上，来优化该评分系统，仍存在争议。误诊和分类错误的风险经常纠缠在一起，但它们并不相同。事实上，虽然理想的诊断需要 100%的敏感性和特异性，但分类标准的目的是聚集具有同质性的患者群体，优先考虑特异性而非敏感性。然而，由于它们经常被要求在临床实践中支持诊断过程，因此出现了一些问题，即这些标准应该有多全面，以及根据关于可测量的 RA 相关异常的新发现，应该多频繁地更新这些标准。在这个观点中，两种不同的观点被提出来讨论了，讨论了现有标准的性能以及根据 ACPA 和 RF 贡献的新数据以及新发现的特异性进行细化的可能性和陷阱。
