MacGregor A J, Bamber S, Silman A J
ARC Epidemiology Research Unit, University of Manchester, UK.
J Rheumatol. 1994 Aug;21(8):1420-6.
We have assessed the importance of the distinction between classification criteria for rheumatoid arthritis (RA) that recognize the presence of currently active disease from those that, in addition, incorporate evidence of past disease activity in ascertaining disease occurrence. We applied 7 classification schemes to a population of twins with inflammatory arthritis to determine (a) the number of individuals classified as RA positive by each scheme and hence the effect on the estimate of disease concordance in the twins and (b) their performance in correctly assigning a diagnosis compared with a physician's opinion.
The schemes assessed were the 1958 ARA (Rome) criteria which detect active disease, the 1966 New York (using both the 2/4 and 3/4 published cutoffs) which detect "ever" disease and 4 variants of the 1987 ARA criteria. These were the 4/7 and decision tree approaches applied on the basis of the relevant features (1) being present at the time of the study and (2) being present ever and allowing current joint deformity to substitute for absent joint swelling.
In all, 283 individuals with a history of joint swelling were assessed, 255 of whom were considered to have RA by their physician. Criteria used to recognize "current" RA identified only about 70% of those which recognized RA ever. These differences in ascertainment level produced a marked effect on the monozygotic twin RA concordance estimates with percentages ranging from 10 to 18%. The results from receiver operating curves confirmed that criteria used to assess only current RA were too insensitive to be of value. Of the criteria that recognized RA status ever the 1987 ARA performed best overall.
The use of classification methods that incorporate past as well as current evidence of disease activity is essential to avoid important misclassification in epidemiological and family studies. The 1987 criteria, applied retrospectively and allowing joint deformity to substitute for swelling, are of enhanced value over other existing schemes.
我们评估了类风湿关节炎（RA）分类标准之间差异的重要性，这些标准有的是识别当前活动性疾病的存在，有的则除此之外还纳入了既往疾病活动的证据来确定疾病的发生情况。我们将7种分类方案应用于患有炎性关节炎的双胞胎人群，以确定（a）每种方案分类为RA阳性的个体数量，从而确定其对双胞胎中疾病一致性估计的影响，以及（b）与医生的诊断意见相比，这些方案在正确诊断方面的表现。
所评估的方案包括检测活动性疾病的1958年美国风湿病学会（ARA，罗马）标准、检测“既往”疾病的1966年纽约标准（使用已公布的2/4和3/4临界值）以及1987年ARA标准的4个变体。这些变体是基于相关特征应用的4/7法和决策树法，相关特征包括（1）在研究时存在，以及（2）曾经存在且允许当前关节畸形替代不存在的关节肿胀。
总共评估了283名有关节肿胀病史的个体，其中255名被医生认为患有RA。用于识别“当前”RA的标准仅识别出约70%那些被识别为“既往”患有RA的个体。这些确诊水平的差异对同卵双胞胎RA一致性估计产生了显著影响，百分比范围为10%至18%。受试者工作特征曲线的结果证实，仅用于评估当前RA的标准过于不敏感，没有价值。在识别“既往”RA状态的标准中，1987年ARA标准总体表现最佳。
使用纳入疾病活动既往和当前证据的分类方法对于避免在流行病学和家族研究中出现重要的错误分类至关重要。回顾性应用且允许关节畸形替代肿胀的1987年标准比其他现有方案具有更高的价值。
