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Early diagnosis of rheumatoid arthritis: an introduction to the newly designed Iran Criteria for Rheumatoid Arthritis

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Abstract

More than 14 years of clinical practice in rheumatology led the author to discover the prognostic role of anti-citrullinated protein antibody (ACPA) as well as the erosions found by MRI, in detecting the RA patients resulting in establishing a new set of criteria by revising the 1987 ACR classification—Iran Criteria for Rheumatoid Arthritis. Medical records of 243 patients at the outpatient Rheumatology Clinic of the author (private sector) were reviewed for the data on the criteria of the 1987 ACR, 2010 ACR/European League against Rheumatism (EULAR), and Iran Criteria for RA. In addition to modifying the 1987 ACR classification, Iran Criteria for RA adds some additional information to the ACR criteria (including ACPA and bony erosions detected by MRI), and any patient who satisfies 6 out of 12 points is considered as a definite RA patient. Sensitivity of the three classifications was calculated considering the clinical diagnosis by a single rheumatologist as the gold standard. A total of 63 male and 180 female patients with a mean follow-up duration of 28.24 ± 50.19 months were considered. Mean age at diagnosis and mean disease duration were 49.16 ± 15.38 years and 7.04 ± 6.87 months, respectively. The sensitivity for Iran Criteria for RA, 1987 ACR classification, and 2010 ACR/EULAR criteria were calculated as 98.4, 59.7, and 66.3%, respectively. Comparing Iran Criteria for RA with ACR and ACR/EULAR criteria, it was concluded that our newly introduced criteria is a more sensitive instrument in determining RA patients in the early stages of the disease.

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References

  1. Serdaroglu M, Cakirbay H, Deger O, Cengiz S, Kul S (2008) The association of anti-CCP antibodies with disease activity in rheumatoid arthritis. Rheumatol Int 28:965–970

    Google Scholar 

  2. Hochberg MC, Spector TD (1990) Epidemiology of rheumatoid arthritis: update. Epidemiol Rev 12:247–252

    Google Scholar 

  3. Lindqvist E, Eberhardt K, Bendtzen K, Heinegard D, Saxne T (2005) Prognostic laboratory markers of joint damage in rheumatoid arthritis. Ann Rheum Dis 64:196–201

    Google Scholar 

  4. de Vries-Bouwstra JK, Goekoop-Ruiterman YP, Verpoort KN et al (2008) Progression of joint damage in early rheumatoid arthritis: association with HLA-DRB1, rheumatoid factor, and anti-citrullinated protein antibodies in relation to different treatment strategies. Arthritis Rheum 58:1293–1298

    Google Scholar 

  5. Zendman AJ, Vossenaar ER, van Venrooij WJ (2004) Autoantibodies to citrullinated (poly)peptides: a key diagnostic and prognostic marker for rheumatoid arthritis. Autoimmunity 37:295–299

    Google Scholar 

  6. Nishimura K, Sugiyama D, Kogata y (2007) Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 146:797–808

    PubMed  Google Scholar 

  7. Whiting PF, Smidt N, Sterne JA et al (2010) Systematic review: accuracy of anti-citrullinated Peptide antibodies for diagnosing rheumatoid arthritis. Ann Intern Med 152(456–64):W155–W166

    Google Scholar 

  8. Combe B, Landewe R, Lukas C et al (2007) EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 66:34–45

    Article  PubMed  CAS  Google Scholar 

  9. Aletaha D, Neogi T, Silman AJ et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69:1580–1588

    Article  PubMed  Google Scholar 

  10. Liao KP, Batra KL, Chibnik L, Schur PH, Costenbader KH (2008) Anti-cyclic citrullinated peptide revised criteria for the classification of rheumatoid arthritis. Ann Rheum Dis 67:1557–1561

    Google Scholar 

  11. Zhao J, Liu X, Wang Z, Li Z (2010) Significance of anti-CCP antibodies in modification of 1987 ACR classification criteria in diagnosis of rheumatoid arthritis. Clin Rheumatol 29:33–38

    Article  PubMed  CAS  Google Scholar 

  12. Saraux A, Berthelot JM, Chales G et al (2001) Ability of the American College of Rheumatology 1987 criteria to predict rheumatoid arthritis in patients with early arthritis and classification of these patients two years later. Arthritis Rheum 44:2485–2491

    Article  PubMed  CAS  Google Scholar 

  13. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  14. Emery P (1994) The Roche Rheumatology Prize Lecture. The optimal management of early rheumatoid disease: the key to preventing disability. Br J Rheumatol 33:765–768

    Google Scholar 

  15. Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS (2004) Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 43:906–914

    Google Scholar 

  16. Symmons DP (2007) Classification criteria for rheumatoid arthritis—time to abandon rheumatoid factor? Rheumatology (Oxford) 46:725–726

    Google Scholar 

  17. van Venrooij WJ, Hazes JM, Visser H (2002) Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis. Neth J Med 60:383–388

    Google Scholar 

  18. Britsemmer K, Ursum J, Gerritsen M, van Tuyl L, van Schaardenburg D (2011) Validation of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: slight improvement over the 1987 ACR criteria. Ann Rheum Dis 70:1468–1470

    Article  PubMed  Google Scholar 

  19. Majithia V, Geraci SA (2007) Rheumatoid arthritis: diagnosis and management. Am J Med 120:936–939

    Google Scholar 

  20. Neogi T, Aletaha D, Silman AJ et al (2010) The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report. Arthritis Rheum 62:2582–2591

    Article  PubMed  Google Scholar 

  21. Garcia-Patos V (2007) Rheumatoid nodule. Semin Cutan Med Surg 26:100–107

    Google Scholar 

  22. Sayah A, English JC (2005) Rheumatoid arthritis: a review of the cutaneous manifestations. J Am Acad Dermatol 53:191–209

    Google Scholar 

  23. McQueen FM (2008) The use of MRI in early RA. Rheumatology (Oxford) 47:1597

Download references

Acknowledgments

We would like to express our sincere gratitude to Farzan Institute for Research & Technology for technical assistance.

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Authors declare any conflict of interest.

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Authors and Affiliations

  1. Rheumatology Research Center, Amir Álam Hospital, Tehran University of Medical Sciences, No 29, 6th Alley, Ghaem-magham St., P.O.Box: 13185-1678, Tehran, Iran

    Iraj Salehi

  2. Tehran, Iran

    Shabnam Khazaeli

  3. Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Khak

  4. Farzan Clinical Research Institute, Tehran, Iran

    Mohammad Khak

Authors
  1. Iraj Salehi
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  2. Shabnam Khazaeli
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  3. Mohammad Khak
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Correspondence to Iraj Salehi.

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Salehi, I., Khazaeli, S. & Khak, M. Early diagnosis of rheumatoid arthritis: an introduction to the newly designed Iran Criteria for Rheumatoid Arthritis. Rheumatol Int 33, 45–50 (2013). https://doi.org/10.1007/s00296-011-2349-1

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  • DOI: https://doi.org/10.1007/s00296-011-2349-1

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