Low-field magnetic resonance imaging or combined ultrasonography and anti-cyclic citrullinated peptide antibody improve correct classification of individuals as established rheumatoid arthritis: results of a population-based, cross-sectional study

BMC Musculoskeletal Disorders

Kim Hørslev-Petersen⁴  Lis S Andersen⁵  Anders J Svendsen⁷  Mikkel Østergaard¹  Anne Voss⁶  Marcin Szkudlarek²  Bo Ejbjerg³  Tove Lorenzen⁵  Jens K Pedersen⁶ 

[1] Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;Department of Rheumatology, University of Copenhagen Hospital at Køge, Køge, Denmark;Department of Rheumatology, Regional Hospital Slagelse, Slagelse, Denmark;Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark;King Christian 10th Hospital for Rheumatic Diseases, South Jutland Hospital, Toldbodgade 3, 6300 Graasten, Denmark;Department of Rheumatology, Odense University Hospital, Odense, Denmark;Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, Denmark

关键词: Epidemiology;    Rheumatoid arthritis;    Magnetic resonance imaging;    Ultrasonography;    Sensitivity and specificity;   

Others  :  1122239
DOI  :  10.1186/1471-2474-15-268

 received in 2013-09-13, accepted in 2014-07-28,  发布年份 2014

【 摘 要 】

Background

The aim of the present study was to evaluate the accuracy of two approaches using magnetic resonance imaging (MRI) or combined ultrasonography (US) and anti-cyclic citrullinated peptide antibody (ACPA) for diagnosis and classification of individuals with established rheumatoid arthritis (RA).

Methods

In 53 individuals from a population-based, cross-sectional study, historic fulfilment of the American College of Rheumatology (ACR) 1987 criteria (“classification”) or RA diagnosed by a rheumatologist (“diagnosis”) were used as standard references. The sensitivity, specificity and Area under Curve for Receiver Operating Characteristics curves (ROC-area: (sensitivity + specificity)/2) were calculated for “current fulfilment of the ACR 1987 criteria” (list format), “adapted ACR 1987 criteria” (list format, substituting IgM rheumatoid factor with ACPA and clinical joint swelling and erosions on radiography with synovitis and erosions detected by US on a semi-quantitative scale), and RA MRI scoring System (RAMRIS) scores on low-field MRI in the unilateral hand.

Results

For the ACR 1987 criteria the ROC-area was 75% (sensitivity/specificity = 50%/100%) (with “classification” as standard reference) and 69% (44%/94%) (with “diagnosis” as standard reference), while for the adapted ACR 1987 criteria it was 86% (75%/97%) (classification) and 82% (72%/91%) (diagnosis). For RAMRIS synovitis score in metacarpophalangeal (MCP) joints only (cut-off ≥5), the ROC-area (sensitivity/specificity) was 78% (62%/94%) (classification) and 85% (69%/100%) (diagnosis), while for the total synovitis score of MCP joints plus wrist (cut-off ≥10) it was 78% (62%/94%) (both classification and diagnosis).

Conclusions

Compared with the ACR 1987 criteria, low-field MRI alone or adapted criteria incorporating US and ACPA increased the correct classification and diagnosis of RA.

【 授权许可】

   
2014 Pedersen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Smolen JS, Landewé R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, Gorter S, Knevel R, Nam J, Schoels M, Aletaha D, Buch M, Gossec L, Huizinga T, Bijlsma JW, Burmester G, Combe B, Cutolo M, Gabay C, Gomez-Reino J, Kouloumas M, Kvien TK, Martin-Mola E, McInnes I, Pavelka K, van Riel P, Scholte M, Scott DL, Sokka T, Valesini G, et al.: EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modyfying antirheumatic drugs. Ann Rheum Dis 2010, 69:964-975.
• [2]Pincus T, Sokka T, Kautiainen H: Patients seen for standard rheumatoid arthritis care have significantly better articular, radiographic, laboratory, and functional status in 2000 than in 1985. Arthritis Rheum 2005, 52:1009-1019.
• [3]Welsing PM, Fransen J, van Riel PL: Is the disease course of rheumatoid arthritis becoming milder? Time trends since 1985 in an inception cohort of early rheumatoid arthritis. Arthritis Rheum 2005, 52:2616-2624.
• [4]Weiss RJ, Stark A, Wick MC, Ehlin A, Palmblad K, Wretenberg P: Orthopaedic surgery of the lower limbs in 49,802 rheumatoid arthritis patients: results from the Swedish National Inpatient Registry during 1987 to 2001. Ann Rheum Dis 2006, 65:335-341.
• [5]Weiss RJ, Ehlin A, Montgomery SM, Wick MC, Stark A, Wretenberg P: Decrease of RA-related orthopaedic surgery of the upper limbs between 1998 and 2004: data from 54,579 Swedish RA inpatients. Rheumatology (Oxford) 2008, 47:491-494.
• [6]Shourt CA, Crowson CS, Gabriel SE, Matteson EL: Orthopedic surgery among patients with rheumatoid arthritis 1980-2007: a population-based study focused on surgery rates, sex, and mortality. J Rheumatol 2012, 39:481-485.
• [7]Dejaco C, Klotz W, Larcher H, Duftner C, Schirmer M, Herold M: Diagnostic value of antibodies against a modified citrullinated vimentin in rheumatoid arthritis. Arthritis Res Ther 2006, 8:R119.
• [8]Coenen D, Verschueren P, Westhovens R, Bossuyt X: Technical and diagnostic performance of 6 assays for the measurement of citrullinated protein/peptide antibodies in the diagnosis of rheumatoid arthritis. Clin Chem 2007, 53:498-504.
• [9]Wakefield RJ, Green MJ, Marzo-Ortega H, Conaghan PG, Gibbon WW, McGonagle D, Proudman S, Emery P: Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 2004, 63:382-385.
• [10]Szkudlarek M, Klarlund M, Narvestad E, Court-Payen M, Strandberg C, Jensen KE, Thomsen HS, Østergaard M: Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination. Arthritis Res Ther 2006, 8:R52.
• [11]Wakefield RJ, Gibbon WW, Conaghan PG, O'Connor P, McGonagle D, Pease C, Green MJ, Veale DJ, Isaacs JD, Emery P: The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000, 43:2762-2770.
• [12]Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M: Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 2001, 44:2018-2023.
• [13]Terslev L, Torp-Pedersen S, Savnik A, von der Recke P, Qvistgaard E, Danneskiold-Samsøe B, Bliddal H: Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum 2003, 48:2434-2441.
• [14]Duer-Jensen A, Vestergaard A, Døhn UM, Ejbjerg B, Hetland ML, Albrecht-Beste E, Østergaard M: Detection of rheumatoid arthritis bone erosions by two different dedicated extremity MRI units and conventional radiography. Ann Rheum Dis 2008, 67:998-1003.
• [15]Ejbjerg BJ, Narvestad E, Jacobsen S, Thomsen HS, Østergaard M: Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography. Ann Rheum Dis 2005, 64:1280-1287.
• [16]Savnik A, Malmskov H, Thomsen HS, Bretlau T, Graff LB, Nielsen H, Danneskiold-Samsøe B, Boesen J, Bliddal H: MRI of the arthritic small joints: comparison of extremity MRI (0.2 T) vs high-field MRI (1.5 T). Eur Radiol 2001, 11:1030-1038.
• [17]Østergaard M, Peterfy C, Conaghan P, McQueen F, Bird P, Ejbjerg B, Shnier R, O'Connor P, Klarlund M, Emery P, Genant H, Lassere M, Edmonds J: OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 2003, 30:1385-1386.
• [18]Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, Wakefield RJ, Manger B, Working Group for Musculoskeletal Ultrasound in the EULAR Standing Committee on International Clinical Studies including Therapeutic Trials: Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001, 60:641-649.
• [19]Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D'Agostino MA, Sanchez EN, Iagnocco A, Schmidt WA, Bruyn GA, Kane D, O'Connor PJ, Manger B, Joshua F, Koski J, Grassi W, Lassere MN, Swen N, Kainberger F, Klauser A, Ostergaard M, Brown AK, Machold KP, Conaghan PG, OMERACT 7 Special Interest Group: Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005, 32:2485-2487.
• [20]Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp JT, Wilder RL, Hunder GG: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988, 31:315-324.
• [21]Pedersen JK, Svendsen AJ, Hørslev-Petersen K: Prevalence of rheumatoid arthritis in the southern part of Denmark. Open Rheumatol J 2011, 5:91-97.
• [22]Bjorner JB, Thunedborg K, Kristensen TS, Modvig J, Bech P: The Danish SF-36 Health Survey: translation and preliminary validity studies. J Clin Epidemiol 1998, 51:991-999.
• [23]Thorsen H, Hansen TM, McKenna SP, Sørensen SF, Whalley D: Adaptation into Danish of the Stanford Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Scale (RAQoL). Scand J Rheumatol 2001, 30:103-109.
• [24]Larsen A, Dale K, Eek M: Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977, 18:481-491.
• [25]Prevoo ML, van t’Hof MA, Kuper HH, van Leuwen MA, van de Putte LB, van Riel PL: Modified disease activity scores that include twenty-eight-joints counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995, 38:44-48.
• [26]Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M: Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003, 48:955-962.
• [27]Ejbjerg BJ, Vestergaard A, Jacobsen S, Thomsen HS, Østergaard M: The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: a comparison of the OMERACT rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the Sharp/van der Heijde radiographic score. Arthritis Rheum 2005, 52:2300-2306.
• [28]Haavardsholm EA, Ostergaard M, Ejbjerg BJ, Kvan NP, Uhlig TA, Lilleås FG, Kvien TK: Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting. Arthritis Rheum 2005, 52:3860-3867.
• [29]DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988, 44:837-845.
• [30]Altman DG: Practical statistics for medical research. London: Chapman and Hall; 1991.
• [31]Banal F, Dougados M, Combescure C, Gossec L: Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis according to disease duration: a systematic literature review and meta-analysis. Ann Rheum Dis 2009, 68:1184-1191.
• [32]Dougados M, Jousse-Joulin S, Mistretta F, D'Agostino MA, Backhaus M, Bentin J, Chalès G, Chary-Valckenaere I, Conaghan P, Etchepare F, Gaudin P, Grassi W, van der Heijde D, Sellam J, Naredo E, Szkudlarek M, Wakefield R, Saraux A: Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination: results from a prospective multicentre study of rheumatoid arthritis. Ann Rheum Dis 2010, 69:828-833.
• [33]Millot F, Clavel G, Etchepare F, Gandjbakhch F, Grados F, Saraux A, Rat AC, Fautrel B, Bourgeois P, Fardellone P, Investigators of the French Early Arthritis Cohort ESPOIR: Musculoskeletal ultrasonography in healthy subjects and ultrasound criteria for early arthritis (the ESPOIR cohort). J Rheumatol 2011, 38:613-620.
• [34]Thiele RG, Schlesinger N: Diagnosis of gout by ultrasound. Rheumatology (Oxford) 2007, 46:1116-1121.
• [35]Wittoek R, Carron P, Verbruggen G: Structural and inflammatory sonographic findings in erosive and non-erosive osteoarthritis of the interphalangeal finger joints. Ann Rheum Dis 2010, 69:2173-2176.
• [36]Guggenbuhl P, Brissot P, Loréal O: Miscellaneous non-inflammatory musculoskeletal conditions. Haemochromatosis: the bone and the joint. Best Pract Res Clin Rheumatol 2011, 25:649-664.
• [37]Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S, Saigo K, Morinobu A, Koshiba M, Kuntz KM, Kamae I, Kumagai S: Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 2007, 146:797-808.
• [38]Liao KP, Batra KL, Chibnik L, Schur PH, Costenbader KH: Anti-cyclic citrullinated peptide revised criteria for the classification of rheumatoid arthritis. Ann Rheum Dis 2008, 67:1557-1561.
• [39]Zhao J, Liu X, Wang Z, Li Z: Significance of anti-CCP antibodies in modification of 1987 ACR classification criteria in diagnosis of rheumatoid arthritis. Clin Rheumatol 2010, 29:33-38.
• [40]Brown AK, Conaghan PG, Karim Z, Quinn MA, Ikeda K, Peterfy CG, Hensor E, Wakefield RJ, O’Conner PJ, Emery P: An explanation for the apparent dissociation between remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008, 58:2958-2967.
• [41]Ostergaard M, Conaghan PG, O'Connor P, Szkudlarek M, Klarlund M, Emery P, Peterfy C, Genant H, McQueen FM, Bird P, Lassere M, Ejbjerg B: Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection – Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS? J Rheumatol 2009, 36:1806-1810.
• [42]Ostergaard M, Møller Døhn U, Duer-Jensen A, Hetland ML, Hørslev-Petersen K, Stengaard-Pedersen K, Junker P, Pødenphant J, Ejbjerg B: Patterns of magnetic resonance imaging bone erosion in rheumatoid arthritis–which bones are most frequently involved and show the most change? J Rheumatol 2011, 38:2014-2017.
• [43]Olech E, Crues JV 3rd, Yocum DE, Merrill JT: Bone marrow edema is the most specific finding for rheumatoid arthritis (RA) on noncontrast magnetic resonance imaging of the hands and wrists: a comparison of patients with RA and healthy controls. J Rheumatol 2010, 37:265-274.
• [44]Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, et al.: 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010, 69:1580-1588.
• [45]MacGregor AJ, Bamber S, Silman AJ: A comparison of the performance of different methods of disease classification for rheumatoid arthritis. Results of an analysis from a nationwide twin study. J Rheumatol 1994, 21:1420-1426.
• [46]Humphreys JH, Verstappen SM, Hyrich KL, Chipping JR, Marshall T, Symmons DP: The incidence of rheumatoid arthritis in the UK: comparisons using the 2010 ACR/EULAR classification criteria and the 1987 ACR classification criteria. Results from the Norfolk Arthritis Register. Ann Rheum Dis 2013, 72:1315-1320.
• [47]Krabben A, Huizinga TW, van der Helm-van Mil AH: Undifferentiated arthritis characteristics and outcomes when applying the 2010 and 1987 criteria for rheumatoid arthritis. Ann Rheum Dis 2012, 71:238-241.
• [48]Humphreys JH, Symmons DP: Postpublication validation of the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: where do we stand? Curr Opin Rheumatol 2013, 25:157-163.
• [49]Guyatt G, Sackett D, Haynes B: Evaluating medical tests. In Clinical epidemiology. How to do clinical practice research. 3rd edition. Edited by Haynes RB, Sackett DL, Guyatt GH, Tugwell P. Philadelphia: Lippincott, Williams and Wilkins; 2006:273-322.