Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Towards a Data-Driven Evaluation of the 2010 ACR/EULAR Criteria for Rheumatoid Arthritis: Is It Sensible To Look at Levels of Rheumatoid Factor?
van der Linden4, M. P. M., Batstra1, M. R., Bakker-Jonges1, L. E., Detert2, J., Bastian2, H., Scherer2, H. U., Burmester2, G. R.
Department of Medical Laboratories, Reinier de Graaf Group, Delft, The Netherlands, on Behalf of SKML-HIM (WGHAS)
Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Berlin, Germany
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
The classification criteria for Rheumatoid Arthritis (RA) have been recently updated. The diagnosis of RA requires achieving >=6 points; anti-citrullinated protein/peptides antibodies (ACPA) or Rheumatoid Factor (RF) presence yields 2 points and high levels 3 points. High RF level has an increased specificity for RA compared to RF-positivity, however the same holds for ACPA-positivity. This study evaluated the prognostic performance of high RF levels compared to the presence of ACPA (as determined by anti-CCP antibodies) for the development of RA. The predictive ability for the severity of RA was also assessed.
Three independent cohorts with a total of 972 undifferentiated arthritis patients were studied for RA-development (according to the 1987 ACR criteria) and arthritis persistency. Positive and negative predictive values (PPV, NPV) and likelihood ratios (LR) were compared for different levels of RF with the presence of anti-CCP antibodies. A similar comparison was made in 686 RA-patients for the rate of joint destruction during 7 years of follow-up and achievement of sustained DMARD-free remission. The variation in RF levels obtained by different measurement methods in the same RF-positive sera was explored.
Presence of anti-CCP had a better balance between LR+/LR- and PPV/NPV than high RF levels for RA-development. The additive value of anti-CCP assessment after high level RF-testing was higher than vice versa. High level RF was less strongly associated with RA severity than anti-CCP antibodies. The RF level obtained by different methods in the same patients' sera varied considerably.
Level determination of RF is subject to large variation; high level RF has limited additive prognostic value compared to anti-CCP-positivity.
To cite this abstract, please use the following information:
van der Linden, M. P. M., Batstra, M. R., Bakker-Jonges, L. E., Detert, J., Bastian, H., Scherer, H. U., et al; Towards a Data-Driven Evaluation of the 2010 ACR/EULAR Criteria for Rheumatoid Arthritis: Is It Sensible To Look at Levels of Rheumatoid Factor? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1780