Background The treatment of early rheumatoid arthritis (RA) should not be delayed. However, aggressive therapy is often introduced only when rheumatogists feel confident enough in their diagnosis of RA.
Objectives We sought the confidence of both office-based-rheumatologists (OBR) and a college of 5 experts in their diagnosis of early-RA.
Methods 270 patients with early-onset (<1 year) arthritis were prospectively followed-up for 29 ± 11 months. At final examination, OBR and a college of 5 experts rated their confidence in the diagnosis of RA on 0–10 and 1–4 analogue scales respectively.
Results 35/270 patients (13%) were still unclassified by their OBR. RA was diagnosed in 114 (42%), spondylarthropathy in 56 (21%), and miscellaneous other disorders in 65 (24%). The OBR confidence in their final diagnosis of RA was 7,5 ± 2,3 (68/114 patients with a confidence of 8/10 or more). A collegial diagnosis of certain RA (N = 57) or probable RA (N = 41) was made for 98 patients. The strength of OBR confidence in the diagnosis of RA was strongly correlated to that of the college (r = 0,892). Conversely, the fulfilment of 4 ACR criteria for RA since the first visit was associated with an only slight increase in final OBR confidence (7,9 ± 2,1).
Conclusion Although only 13/114 (11%) patients finally classified as RA changed from diagnosis during follow-up, the final confidence of OBR in their diagnosis of RA were below 8/10 in 40%, and was only slightly improved by the fulfilment of ACR criteria. This emphasises the need for a close follow-up of these patients during the first years and the use of RA criteria for the classification of early arthritis.
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