Toward a data-driven evaluation of the 2010 American College of Rheumatology/European League Against Rheumatism criteria for rheumatoid arthritis: is it sensible to look at levels of rheumatoid factor?

OBJECTIVE Recently, new classification criteria for rheumatoid arthritis (RA) have been devised by methodology that used first a quantitative approach (data from databases), then a qualitative approach (consensus; based on paper patients), and finally a common sense-based approach (evaluation of the former phases). Now the individual items that make up these criteria are being evaluated. This study was undertaken to analyze the item "autoantibodies," in particular rheumatoid factor (RF) level. METHODS Three separate cohorts comprising a total of 972 patients with undifferentiated arthritis were studied for RA development (according to the 1987 American College of Rheumatology criteria) and arthritis persistence. The positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were compared between different levels of RF and the presence of anti-citrullinated protein antibody (ACPA). A similar comparison was made in 686 RA patients for the rate of joint destruction and achievement of sustained disease-modifying antirheumatic drug-free remission during 7 years of followup. The variation in RF levels obtained by different measurement methods in the same RF-positive sera was explored. RESULTS Compared to high RF levels, presence of ACPA had a better balance between positive LR and negative LR and between PPV and NPV for RA development. The additive value of ACPA assessment after testing for RF level was higher than vice versa. The association between high RF level and RA severity was not as strong as that between ACPA antibodies and RA severity. The RF level obtained by different methods in the same patients' sera varied considerably. CONCLUSION Our findings indicate that determination of RF level is subject to large variation; high RF level has limited additive prognostic value compared to ACPA positivity. Thus, omitting RF level and using RF presence, ACPA presence, and ACPA level may improve the 2010 criteria for RA.

[1]  A. Silman,et al.  The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report. , 2010, Arthritis and rheumatism.

[2]  A. Silman,et al.  The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Methodological Report Phase I , 2010, Annals of the rheumatic diseases.

[3]  A. Silman,et al.  Rheumatoid arthritis classifi cation criteria : an American College of Rheumatology / European League Against Rheumatism collaborative initiative , 2010 .

[4]  D. M. van der Heijde,et al.  The prognostic value of baseline erosions in undifferentiated arthritis , 2009, Arthritis research & therapy.

[5]  T. Huizinga,et al.  Value of anti-modified citrullinated vimentin and third-generation anti-cyclic citrullinated peptide compared with second-generation anti-cyclic citrullinated peptide and rheumatoid factor in predicting disease outcome in undifferentiated arthritis and rheumatoid arthritis. , 2009, Arthritis and rheumatism.

[6]  P. Gregersen,et al.  Association of a single-nucleotide polymorphism in CD40 with the rate of joint destruction in rheumatoid arthritis. , 2009, Arthritis and rheumatism.

[7]  D. M. van der Heijde,et al.  Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: results from two large early arthritis cohorts. , 2009, Arthritis and rheumatism.

[8]  T. Kvien,et al.  Pattern of Joint Involvement and Other Disease Characteristics in 634 Patients with Arthritis of Less Than 16 Weeks’ Duration , 2009, The Journal of Rheumatology.

[9]  Saskia le Cessie,et al.  A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: how to guide individual treatment decisions. , 2007, Arthritis and rheumatism.

[10]  G. Burmester,et al.  Update Früharthritis und frühe rheumatoide Arthritis , 2005 .

[11]  H. Heinzl,et al.  Autoantibody profiling as early diagnostic and prognostic tool for rheumatoid arthritis , 2005, Annals of the rheumatic diseases.

[12]  C. Allaart,et al.  The Leiden Early Arthritis Clinic. , 2003, Clinical and experimental rheumatology.

[13]  B. Dijkmans,et al.  Rheumatoid factor and antibodies to cyclic citrullinated Peptide differentiate rheumatoid arthritis from undifferentiated polyarthritis in patients with early arthritis. , 2002, The Journal of rheumatology.

[14]  P. Shekelle,et al.  How to read radiographs according to the Sharp/van der Heijde method. , 1999 .

[15]  F. Arnett.  Revised criteria for the classification of rheumatoid arthritis. , 1990, Orthopedic nursing.

[16]  F. Breedveld,et al.  Quantitative detection of class-specific rheumatoid factors using mouse monoclonal antibodies and the biotin/streptavidin enhancement system. , 1989, British journal of rheumatology.

[17]  M. Liang,et al.  The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. , 1988, Arthritis and rheumatism.

[18]  F. K. And,et al.  Standardisation of serological tests for rheumatoid factor measurement. , 1987, Annals of the rheumatic diseases.

[19]  P. Bacon,et al.  Clinical value of ELISA assays for IgM and IgG rheumatoid factors. , 1987, Journal of clinical pathology.

[20]  T. Huizinga,et al.  Predicting arthritis outcomes--what can be learned from the Leiden Early Arthritis Clinic? , 2011, Rheumatology.