Extended reports
Diagnostic evaluation of classification criteria for rheumatoid
arthritis and reactive arthritis in an early synovitis outpatient
clinic
Division of
Rheumatology, Department of Internal Medicine, School of Medicine,
Hannover, Carl-Neuberg-Stra
e 1, 30625 Hannover, Germany
Correspondence to: Dr J L Hülsemann.
Accepted for publication 10 February 1999
OBJECTIVE
To evaluate
the diagnostic performance of classification criteria for rheumatoid
arthritis (RA) and reactive arthritis (ReA) in an early synovitis
outpatient clinic.
METHODSIn a
prospective two year survey consecutive patients with early synovitis
of less than one year duration were documented using a standardised
registry and were classified after an expert diagnosis. Of a total of
320 patients 39 (19%) were diagnosed as having RA, 24 (11%) patients
had ReA, 117 (54%) patients did not have an unequivocal diagnosis, and
were considered as undifferentiated arthritis.
RESULTSThe
retrospective application of the revised 1987 ACR criteria for the
classification of RA in this data set revealed a sensitivity of
90% and a specificity of 90%. The positive predictive value was 0.67, the negative predictive value 0.98. Similarly, the criteria for ReA of
the French Society of Rheumatology (FSR) showed a sensitivity of 80%
and a specificity of 90% with a positive predictive value of 0.55 and
a negative predictive value of 0.97. Both criteria sets had a
satisfying likelihood ratio of 9 and 10, respectively.
CONCLUSIONBoth the
1987 ACR criteria for RA and the criteria of the FSR for ReA have a
reasonable diagnostic validity in patients with early synovitis,
including a large portion of undifferentiated arthritis.
© 1999 by Annals of the Rheumatic Diseases
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