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Misdiagnosis of Rheumatoid Arthritis in a Long-Term Cohort of Early Arthritis Based on the ACR-1987 Classification Criteria

Agelii, Monica Leu ; Hafström, Ingiäld ; Svensson, Björn LU ; Ajeganova, Sofia ; Forslind, Kristina LU ; Andersson, Maria LU orcid and Gjertsson, Inger (2022) In Open Access Rheumatology: Research and Reviews 14. p.187-194
Abstract

Objective: Correct diagnosis of early rheumatoid arthritis (RA) is essential for optimal treatment choices. No pathognomonic test is available, and diagnosis is based on classification criteria, which can result in misdiagnosis. Here, we examined the differences between actual and misdiagnosed RA cases in a long-term cohort of patients included based on the ACR-1987 classification criteria. Methods: Patients in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) cohort (n=2543) with at least four follow-up visits during the initial 5 years from enrolment were assessed, and a change in diagnosis was reported by the treating rheumatologist. The groups were analysed with respect to the individual classification criteria, antibodies to... (More)

Objective: Correct diagnosis of early rheumatoid arthritis (RA) is essential for optimal treatment choices. No pathognomonic test is available, and diagnosis is based on classification criteria, which can result in misdiagnosis. Here, we examined the differences between actual and misdiagnosed RA cases in a long-term cohort of patients included based on the ACR-1987 classification criteria. Methods: Patients in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) cohort (n=2543) with at least four follow-up visits during the initial 5 years from enrolment were assessed, and a change in diagnosis was reported by the treating rheumatologist. The groups were analysed with respect to the individual classification criteria, antibodies to citrullinated proteins (ACPA), disease activity (DAS28) and radiographic changes from inclusion up to 2 years. Results: Forty-five patients (1.8%) were misdiagnosed (RA-change group). When compared to those in the RA-change group, the patients who kept their diagnosis (RA-keep) were more often RF positive (64% vs 21%, p<0.001) or ACPA positive (59% vs 8%, p<0.001). They were also more likely to fulfil more than four ACR-1987 criteria (64% vs 33%, p<0.001) and to have radiographic changes at inclusion (RA-keep 27% vs RA-change 12%, p=0.04). The groups had a similar evolution of DAS28 and its components as well as of radiological joint destruction. Conclusion: Diagnosis of RA according to the ACR-1987 criteria had a high precision in this long-term cohort. A diagnosis of RA should be re-evaluated in patients who do not fulfil more than four ACR-1987 criteria especially in patients negative for RF.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ACPA, ACR-1987 classification criteria, arthritis, precision, rheumatoid factor
in
Open Access Rheumatology: Research and Reviews
volume
14
pages
8 pages
publisher
Dove Medical Press Ltd.
external identifiers
  • scopus:85138914403
  • pmid:36172258
ISSN
1179-156X
DOI
10.2147/OARRR.S372724
language
English
LU publication?
yes
id
baeb0c4f-4c63-4b4f-825b-0a490030bdc2
date added to LUP
2023-01-16 11:14:36
date last changed
2024-09-20 10:05:48
@article{baeb0c4f-4c63-4b4f-825b-0a490030bdc2,
  abstract     = {{<p>Objective: Correct diagnosis of early rheumatoid arthritis (RA) is essential for optimal treatment choices. No pathognomonic test is available, and diagnosis is based on classification criteria, which can result in misdiagnosis. Here, we examined the differences between actual and misdiagnosed RA cases in a long-term cohort of patients included based on the ACR-1987 classification criteria. Methods: Patients in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) cohort (n=2543) with at least four follow-up visits during the initial 5 years from enrolment were assessed, and a change in diagnosis was reported by the treating rheumatologist. The groups were analysed with respect to the individual classification criteria, antibodies to citrullinated proteins (ACPA), disease activity (DAS28) and radiographic changes from inclusion up to 2 years. Results: Forty-five patients (1.8%) were misdiagnosed (RA-change group). When compared to those in the RA-change group, the patients who kept their diagnosis (RA-keep) were more often RF positive (64% vs 21%, p&lt;0.001) or ACPA positive (59% vs 8%, p&lt;0.001). They were also more likely to fulfil more than four ACR-1987 criteria (64% vs 33%, p&lt;0.001) and to have radiographic changes at inclusion (RA-keep 27% vs RA-change 12%, p=0.04). The groups had a similar evolution of DAS28 and its components as well as of radiological joint destruction. Conclusion: Diagnosis of RA according to the ACR-1987 criteria had a high precision in this long-term cohort. A diagnosis of RA should be re-evaluated in patients who do not fulfil more than four ACR-1987 criteria especially in patients negative for RF.</p>}},
  author       = {{Agelii, Monica Leu and Hafström, Ingiäld and Svensson, Björn and Ajeganova, Sofia and Forslind, Kristina and Andersson, Maria and Gjertsson, Inger}},
  issn         = {{1179-156X}},
  keywords     = {{ACPA; ACR-1987 classification criteria; arthritis; precision; rheumatoid factor}},
  language     = {{eng}},
  pages        = {{187--194}},
  publisher    = {{Dove Medical Press Ltd.}},
  series       = {{Open Access Rheumatology: Research and Reviews}},
  title        = {{Misdiagnosis of Rheumatoid Arthritis in a Long-Term Cohort of Early Arthritis Based on the ACR-1987 Classification Criteria}},
  url          = {{http://dx.doi.org/10.2147/OARRR.S372724}},
  doi          = {{10.2147/OARRR.S372724}},
  volume       = {{14}},
  year         = {{2022}},
}