Background Early diagnosis is very important for RA. The 2010 ACR/EULAR RA classification criteria has been mainly developed for this purpose. However, these new criteria may cause RA overdiagnosis.
Objectives We aimed to determine the “real” RA in patients followed up with RA diagnosis and also compare the performance of 1987 and 2010 RA classification criteria in real life.
Methods We analyzed 209 consecutive patients admitted to Hitit University Çorum Education and Research Hospital and Ankara Numune Education and Research Hospital rheumatology clinic who were diagnosed as RA and on a disease modifying anti-rheumatic drug (DMARD) therapy. Especially patients without typical seropositive RA were researched for a “true” diagnosis by history, physical examination, acute phase reactants, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and if necessary further tests. 85.2% of the patients were female and their median age was 53 (21-79). One hundred and twenty (57.4%) patients were diagnosed by a rheumatologist, 78 (37.3%) were diagnosed by a specialist of physical medicine and rehabilitation, 6 (2,9%) were diagnosed by a internist and 5 (2,4%) by other. The median follow-up period was 36 months (1-360). At the time of diagnosis 136 (65.1%) patients were presented with polyarthritis, 28 (13.4%) with oligoarthritis and 7 (3.3%) with monoarthritis. 138 (66%) of the patients had symmetric arthritis and 134 (64.1%) had morning stiffness lasting more than 30 minutes. 100 (47.8%) patients were presented with a high erytrocyte sedimentation rate and 130 (62.2%) were presented with a high serum C-reactive protein level. 136 (65.1%) were seropositive for RF and 54% were seropositive for anti-CCP. The drugs were also recorded. 104 (49.8%) of the patients were on NSAID therapy, 135 (64.6%) were on low dose steroid therapy, 137 (65.6%) were on hydroxychloroquine, 59 (28.2%) were on sulphasalazine, 138 (66%) were on methotrexate, 69 (33%) were on leflunomide therapy and 13 (6.2%) were on biologic DMARDS.
Results 19 (9.1%) of these patients who were previously diagnosed as RA had no longer symptoms, therefore we offered them discontinuation of DMARD therapy. When the remaining patients were reanalyzed, 50 (23.9%) patients had different diasease. 16 (7.7%) had Sjogren or another collagen vascular disease, 14 (6.7%) had psoriatic arthritis or another spondiloarthropathies, 5 (2.4%) had undifferentiated arthritis, 4 (1.9%) had osteoarthritis, 3 (1.4%) had crystal arthritis, 2 (1%) had polymyalgia rheumatica and 6 (2.9%) of them had other diseases.
In our study, 140 patients were classified for RA according to 1987 ACR and 2010 ACR/EULAR RA criteria. 94 (67.1%) patients fulfilled 1987 ACR criteria, 135 (96.4%) fulfilled 2010 ACR/EULAR criteria, and 92 (65.7%) patients fulfilled both of them.
Conclusions In conclusion, we established that one third of patients followed up with RA diagnosis in clinical practise had transient undifferantiated arthritis or any disease other than RA. In diagnosis of “real” RA, the new criteria detect more patients than 1987 criteria (96.4% vs 67.1%). According to these findings, we think especially that RF and anti-CCP negative RA patients should be re-evaluated for “real” RA diagnose.
Disclosure of Interest None declared
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