Diagnosing early or rheumatoid arthritis. Which is better: expert opinion or evidence?
Open Access
- 5 November 2009
- journal article
- Published by The Journal of Rheumatology in The Journal of Rheumatology
- Vol. 36 (11), 2375-2377
- https://doi.org/10.3899/jrheum.091045
Abstract
All clinicians know about the complexity in diagnosing rheumatoid arthritis (RA), especially early in the disease. Because RA lacks pathognomonic features — that is, there are no clinical, biological, or radiological characteristics specific to RA diagnosis — doubt about the diagnosis may persist for some patients1,2. Examples are patients with “nude” polyarthritis [i.e., without positivity for serum rheumatoid factor (RF), anti-citrullinated peptide antibodies, typical erosion, or all 3], or even elderly people with erosive RF-positive polyarthritis associated with psoriasis or calcium crystal deposition disease features seen on joint radiography. When RA is neither obvious nor completely excluded, the clinician strikes a balance between possible or probable RA, depending on the level of confidence. In this context, in clinical research, RA classification criteria may be of some help because they ensure, at the group level, the diagnosis of RA with minimal error. However, in clinical practice, RA criteria cannot be used as the gold standard, especially in early arthritis (EA), as was previously shown3–5. In this issue of The Journal, Morvan, et al report on a cohort of patients with EA followed for 10 years to investigate discrepancies in RA diagnosed by American College of Rheumatology (ACR) classification criteria and final diagnosis by an office-based rheumatologist6. The authors noted poor agreement at the onset of the disease, as has been shown, but also at 2 years, when ACR criteria are supposed to be more accurate. If one assumes that the rheumatologist is an expert, who is right: the expert or the criteria? Eminence … Address correspondence to Dr. B. Fautrel, Department of Rheumatology, Pitié-Salpêtrière Hospital, 83 boulevard de l’Hôpital, 75651 Paris cedex 13, France. E-mail: bruno.fautrel{at}psl.aphp.frKeywords
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