Background The early diagnosis of rheumatoid arthritis (RA) is important, as prompt treatment minimizes joint damage. However,detecting early RA in the community is a challenge, particularly in resource poor settings. The questionnaire based early inflammatory arthritis detection tool (EIA-3) was developed for early detection of inflammatory joint diseases in the community. But, this tool has no examination component. Therefore, this community based study examines whether screening for early RA by the EIA-3 (1) will be improved by addition of examination for a tender joints.
Objectives 1. To describe the proportion of adults from the Pitakotte Health Division (PHD), a suburb in Colombo, Sri Lanka, who would be detected with early inflammatory arthritis based on:
– EIA-3 detection tool alone;
– EIA-3 after addition of at least one tender joint on the 53 joints counted by the Ritchie Articular Index (RAI).
2. Compare the EIA-3 before/after adding joint count as a screening tool to detect early RA using the ACR/EULAR 2010 classification criteria for RA as a gold standard.
Methods This descriptive cross sectional household study was conducted in the PHD. Persons aged 16-60 years (n=1022) without a previously diagnosed rheumatological condition were selected using a multistage cluster sampling technique. A health sub-division (HSD) was defined as a cluster. This study was conducted in 7 HSD randomly selected from 12 clusters. Four physiotherapists trained in data collection and joint counts collected data by visiting households after obtaining informed consent. The EIA-3 detection tool was translated into two local languages. This tool was included in a pretested interviewer administered questionnaire that also assessed socio-demographics and RAI. Persons with at least one tender joint on the 53 joint count of the RAI were revaluated using ACR/EULAR classification criteria (2) by a consultant rheumatologist after rheumatoid factor and anti cyclic citrullinated peptide antibody testing.
Results The study population comprised 1022 persons (females -51.2%) with a mean age of 48.3 (±4.3) years. 48 (4.7%) were categorized as early inflammatory arthritis based on EIA-3 tool while 39 (3.9%) had at least one tender joint in addition. 36/39 identified by EIA-3 and joint count consented for investigations. Of them, 7 (19%) were diagnosed with RA based on ACR/EULAR 2010 criteria. EIA-3 performance with/without the joint count was compared (Table 1). EIA-3 before and after adding the joint count showed agreement in 1007/1022 (98.5%). Of those assessed, 13.8% with a positive EIA-3 alone and 19.4% with EIA and at least one tender joint were confirmed to have RA based on ACR/EULAR criteria (p=0.59).
Conclusions Combination of EIA-3 with a single tender joint from 53 joints of the Ritchie Articular Index did not significantly improve the usefulness of this screening tool. This study confirms that the entirely questionnaire based EIA-3 is adequate on its own to identify early rheumatoid arthritis in a resource poor community setting.
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Alves C et al. Ann Rheum Dis 2011;70(9), 1645-1647.
Disclosure of Interest None declared