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Does adding the presence of MRI detected bone marrow oedema improve the accuracy of the 2010 EULAR/ACR criteria for rheumatoid arthritis?
  1. Wouter P Nieuwenhuis1,
  2. Monique Reijnierse2,
  3. Annette HM van der Helm-van Mil1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of radiology, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Wouter P Nieuwenhuis, Department of Rheumatology, Leiden University Medical Center, Postbus 9600, Leiden 2300RC, The Netherlands; w.p.nieuwenhuis{at}

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With great interest we read the letter of Tamai et al who studied whether adding information obtained by MRI of wrist and metacarpophalangeal (MCP) joints to the existing 2010 European League against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for rheumatoid arthritis (RA) was helpful in improving the accuracy of these criteria. The study population was patients with undifferentiated arthritis according to the 1987 classification criteria. Two outcomes were studied: fulfilling the 1987 classification criteria for RA after 1-year of disease and the start of disease-modifying antirheumatic drugs (DMARDs) within the first year.1 The results on MRI detected bone marrow oedema (BME) added to the 2010 criteria with the start of DMARDs as outcome were most interesting. The sensitivity and specificity of the 2010 criteria without addition of BME were 61.9% and 82.6% respectively and the accuracy 70.5%. After adding information on BME, an increase in sensitivity and accuracy was observed (76.3% and 75.9%, respectively); this was accompanied by a decline in specificity (75.4%). Area under receiver operator characteristic curves (AUCs) were not reported.1

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