Abstract
Objectives. To validate van der Helm-van Mil score (vHvM) and new ACR/EULAR criteria for the diagnosis of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA). Patients and Methods. Adult patients with UA (swelling ≥2 joints of less than 6 months duration, without diagnosis, and never treated with disease modifying drugs). Results. Ninety-one patients were included. Mean age: 55.6 years (SD: 17.4), 74% females. Median symptoms duration was 2 months (IR: 1–4 months). Mean van der Helm-van Mil score was 6.9 (SD: 2). After a mean followup of 6.2 months (SD: 6), 40.7% patients fulfilled ACR 1987 RA classification criteria, 28.6% fulfilled other diagnostic criteria, and 31% remained as UA. Receiver operator characteristic curve's (ROC's) area under the curve (AUC) for the vHvM score for diagnosis of RA was 0.83. A cutoff value of 6.94 showed sensitivity of 81% and 79.7% specificity. For the new ACR/EULAR criteria, the ROC AUC was 0.93, and a value equal to or greater than 6 showed 86.5% sensitivity and 87% specificity. Conclusion. van der Helm-van Mil prediction score and the new ACR/EULAR criteria proved to be valuable for the diagnosis of RA in patients with early UA.
Highlights
Rheumatoid arthritis (RA) is a systemic disease characterized by chronic inflammation that often leads to joint destruction
The majority of patients who present with recent onset arthritis have undifferentiated arthritis (UA) which is a form of arthritis that does not fulfill the classification criteria for a more definitive diagnosis
UA was defined as swelling in 2 or more joints revealed on physical examination of less than 6 months of disease duration without a definite diagnosis and who had never been treated with any disease modifying antirheumatic drug (DMARD)
Summary
Rheumatoid arthritis (RA) is a systemic disease characterized by chronic inflammation that often leads to joint destruction. A greater awareness of RA [1, 2] has led to new efforts in order to establish a definitive diagnosis as early as possible after onset of symptoms [1,2,3,4]. The American College of Rheumatology (ACR) 1987 [5] classification criteria for RA were developed for clinical trials and research purposes, and it is not an appropriate tool for applying in the very early phase of the disease, mainly because of low sensitivity [6]. The majority of patients who present with recent onset arthritis have undifferentiated arthritis (UA) which is a form of arthritis that does not fulfill the classification criteria for a more definitive diagnosis. According to the UA evolution mentioned previously, we believe that the consequences of over- or undertreatment of this disease are a keynote issue
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