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Abstract Number: 2274

Assessment Of The Diagnostic Accuracy Of Different Strategies For Health Fair Case-Finding For Undiagnosed Inflammatory Arthritis

Kaylynn Aiona1, Christopher C. Striebich2, M. Kristen Demoruelle3, Julia J. Rhiannon4, Stuart M. Weisman5, Marie L. Feser3, Lezlie A. Derber5, James H. Goddard6, Stacey Brake6, Jill Lysengen7, Laura Rosseisen7, John E. Hokanson1, Anna E. Baron1, Jill M. Norris8, V. Michael Holers9 and Kevin D. Deane3, 1Colorado School of Public Health, Aurora, CO, 2University of Colorado Denver, Aurora, CO, 3Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, 4Rheumatology, University of Colorado School of Medicine, Aurora, CO, 5University of Colorado School of Medicine, Division of Rheumatology, Aurora, CO, 69Health Fair, Denver, CO, 7Arthritis Foundation, Great West Region, Denver Office, Denver, CO, 8Epidemiology, Colorado School of Public Health, Aurora, CO, 9Rheumatology Division, University of Colorado School of Medicine, Aurora, CO

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Community programs, Diagnostic Tests, Inflammatory arthritis and rheumatoid arthritis (RA)

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Session Information

Session Title: Rheumatoid Arthritis-Clinical Aspects III: Outcome Measures, Socioeconomy, Screening, Biomarkers in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:  

Early treatment of inflammatory arthritis (IA), and especially rheumatoid arthritis (RA), leads to improved outcomes, although diagnostic delays may impede timely treatment. We hypothesized that case finding in a community based health fair may improve the timing of diagnosis and treatment of IA. However, the diagnostic accuracy of this approach in a health fair where IA is likely rare is largely unknown. Therefore, we developed and tested the diagnostic accuracy of a case-finding strategy for IA in a Colorado-based health fair.

Methods:  

Volunteers were evaluated between 2009-2012 at 18 health fair sites using a self-reported joint symptom questionnaire and CCP3 (INOVA; ≥20 units positive) and RF (Roche RFII; >14 units positive) testing. IA was defined as synovitis identified by a trained clinician on examination of the wrists, elbows, and PIP and MCP joints performed at the same time as the questionnaire and blood testing.

Results:  

3260 volunteers completed a questionnaire, joint examination and blood testing; 164 (5%) were identified with active, previously undiagnosed IA, of whom 33/164 (20%) were classified as RA by 2010 ACR/EULAR criteria. After modifications of an initial questionnaire to improve its ease of use and sensitivity for IA, the optimal prediction model for IA (multiple regression; bootstrap validated AUC of 0.73) included 4 items that each contributed similarly to the model: CCP positivity and self-reported: a) morning stiffness ≥1 hour, b) nodules, and c) joint pain, stiffness or swelling present the day of questionnaire completion. The maximal sensitivity (SENS) for IA was with ≥1 item positive (96%; corresponding specificity (SPEC) of 24%); ≥2 positive items resulted in the highest combination of SENS and SPEC (85% and 52%, respectively). In 2012 we piloted a questionnaire with a figure for subjects to identify symptom location, and symptoms in PIPs and MCPs were 93% SENS and 65% SPEC for IA, although there were too few cases of IA (N=15 out of 338 subjects) to evaluate adequately the diagnostic accuracy of additional factors. CCP and/or RF were positive in 279/3260 (9%) of subjects, and both autoantibodies (Abs) were independently significantly associated with IA (p<0.01 and 0.03, respectively). In evaluation of the diagnostic accuracy of Abs alone for IA, CCP and/or RF positivity was 11% SENS and 92% SPEC for IA, reflecting that most IA was seronegative. Additionally, CCP and RF levels >3 times normal were each highly specific for IA (CCP: SENS 5%, SPEC 99%; RF: SENS 5%, SPEC 99%).

Conclusion:  

Assessing self-reported symptoms and Abs in a health fair may identify previously undiagnosed IA/RA. As such, these items may be used initially independently of a clinician thus broadening the applicability of this approach to settings where trained joint examiners are absent. Further testing is necessary to validate these findings and to determine whether case-finding accuracy may be improved by ascertaining specific locations of joint symptoms. Additionally, determining final formal diagnoses, timing of treatment for IA, and post-health fair costs (including costs of evaluating false-positive results) will help determine the overall impact of this approach in arthritis care.


Disclosure:

K. Aiona,
None;

C. C. Striebich,
None;

M. K. Demoruelle,
None;

J. J. Rhiannon,
None;

S. M. Weisman,
None;

M. L. Feser,
None;

L. A. Derber,
None;

J. H. Goddard,
None;

S. Brake,
None;

J. Lysengen,
None;

L. Rosseisen,
None;

J. E. Hokanson,
None;

A. E. Baron,
None;

J. M. Norris,
None;

V. M. Holers,
None;

K. D. Deane,

AbbVie,

2.

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