Background/Purpose:
In the articles describing the 2010 rheumatoid arthritis (RA) classification criteria , it is stated that additional evidence of joint injury from imaging techniques such as magnetic resonance imaging (MRI) may be used for confirmation of the clinical findings. MRI is able to detect synovitis, tenosynovitis, osteitis and bone erosion. Among these, osteitis, is supposed to be the best surrogate MRI feature for differentiating RA from other rheumatic diseases. This study is undertaken to investigate whether MRI-proven osteitis improves the diagnostic performance of the 2010 RA classification criteria among early arthritis patients.
Methods:
All of early arthritis patients, whose disease duration at entry less than 6 months, were recruited in the present study from Nagasaki University Early Arthritis Cohort. Patients whose diagnoses were compatible with rheumatic diseases other than RA or obvious to plain radiographic erosion at entry, were excluded. All of the subjects underwent physical examination, blood tests, and gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRI on the same day. Gold-standard RA was defined as the patients receiving disease-modifying antirheumatic drugs during the first year. The diagnostic performance of the 2010 RA criteria with or without the finding of MRI-proven joint injury was investigated.
Results:
One hundred sixty-four patients, whose median disease duration at entry was 2 months, were recruited. The median values for age, CRP (mg/l), prevalence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) at examination were 54 years, 2.0, 40.2% and 34.1%, respectively. The 2010 RA classification criteria classified RA with a sensitivity of 62.4%, a specificity of 83.1%, a positive predictive value (PPV) of 82.9%, a negative predictive value (NPV) of 62.8%, accuracy of 71.3%. Osteitis was the most specific MRI finding in gold-standard RA . We have proposed a decision-tree algorithm that involves initially applying the 2010 RA classification criteria, and if the patients do not fulfill 2010 RA classification criteria, the MRI-proven osteitis rule is introduced. The tree algorithm has been shown to differentiate patients more efficiently than the 2010 RA classification criteria alone, exhibiting a sensitivity of 79.6%, a specificity of 76.1%, a PPV of 81.3%, a NPV of 74.0%, accuracy of 78.0%.
Conclusion:
The present data indicate that the combination of MRI-proven osteitis with the 2010 RA classification criteria improves the diagnostic probability of RA at an early stage.
Disclosure:
M. Tamai,
None;
J. Kita,
None;
Y. Nakashima,
None;
A. Nishino,
None;
T. Suzuki,
None;
Y. Horai,
None;
A. Okada,
None;
T. Koga,
None;
S. Y. Kawashiri,
None;
N. Iwamoto,
None;
K. Ichinose,
None;
K. Arima,
None;
S. Yamasaki,
None;
H. Nakamura,
None;
T. Origuchi,
None;
M. Uetani,
None;
A. Fukushima,
None;
K. Aoyagi,
None;
K. Eguchi,
UCB Pharma,
5;
A. Kawakami,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/combination-of-magnetic-resonance-imaging-proven-osteitis-with-2010-ra-classification-criteria-improves-the-diagnostic-probability-of-early-rheumatoid-arthritis-whose-disease-duration-less-than-6-mont/