"The main criteria used in RA are the American College of Rheumatology, ACR, or American Rheumatism Association 1987 revised criteria, published by Arnett et al," say Frederic Banal (Cochin Hospital, Paris, France) and colleagues.
"Although these criteria were developed as classification criteria, they are widely used for diagnosis," the authors write in the Annals of the Rheumatic Diseases.
In addition to being unsuitable for diagnosing RA, most of the points on the criteria are not seen in the early stages of RA meaning that the tool is likely to lack sensitivity in patients with a disease duration of 1 year or less, suggest the investigators.
To verify this suggestion, Banal and co-workers performed a systematic review of literature published in the Pubmed and Embase databases.
The authors looked specifically for articles reporting the prevalence of RA according to ACR criteria and expert opinion. The researchers identified 19 suitable studies that included a total of 7438 patients, 3883 of whom had RA.
By collating data from these studies, the investigators showed that the ACR criteria had a pooled sensitivity and specificity for detecting early RA of 77% each when the list format was used, or 80% sensitivity and 33% specificity when the tree format was used.
Sensitivity and specificity were significantly better at 79% and 90%, respectively, when using the list format in patients with established RA, and 80% and 93%, respectively, when using the tree format.
"In conclusion, this systematic review allowed us to determine the diagnostic capacity of the 'gold standard' classification criteria in RA and our results may be used as a basis when assessing new diagnostic criteria in RA," write the investigators.
Based on their findings, the researchers conclude: "It may be time to revise the 1987 ACR Classification Criteria for RA to take into account changes that have appeared over the past 20 years, and to develop more sensitive criteria for diagnosis of early RA."
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DUH!!!!!!!!!!