Rheumatoid arthritis diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Rheumatoid arthritis}}
{{Rheumatoid arthritis}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{MKK}}
== Overview ==
== Overview ==
Anti-CCP antibodies testing is the gold standard test for the diagnosis of [[rheumatoid arthritis]]. It has the specificity of about 81-100%, with the sensitivity of 39–94%.
== Diagnostic Study of Choice ==
*Anti-CCP antibodies testing is the gold standard test for the diagnosis of [[rheumatoid arthritis]].<ref name="pmid12607587">{{cite journal |vauthors=van Venrooij WJ, Hazes JM, Visser H |title=Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis |journal=Neth J Med |volume=60 |issue=10 |pages=383–8 |date=November 2002 |pmid=12607587 |doi= |url=}}</ref><ref name="pmid10643712">{{cite journal |vauthors=Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC, van Venrooij WJ |title=The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide |journal=Arthritis Rheum. |volume=43 |issue=1 |pages=155–63 |date=January 2000 |pmid=10643712 |doi=10.1002/1529-0131(200001)43:1<155::AID-ANR20>3.0.CO;2-3 |url=}}</ref>
**It has the specificity of about 81-100%, with the sensitivity of 39–94%.


== Diagnostic Study of Choice ==
=== Diagnostic Criteria ===
'''The 2010 American College of Rheumatology classification criteria for diagnosis of rheumatoid arthritis:'''<ref name="pmid20872595">{{cite journal |vauthors=Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 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, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G |title=2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative |journal=Arthritis Rheum. |volume=62 |issue=9 |pages=2569–81 |date=September 2010 |pmid=20872595 |doi=10.1002/art.27584 |url=}}</ref><ref name="pmid12415587">{{cite journal |vauthors=Maksymowych WP, Suarez-Almazor ME, Buenviaje H, Cooper BL, Degeus C, Thompson M, Russell AS |title=HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis |journal=J. Rheumatol. |volume=29 |issue=11 |pages=2319–26 |date=November 2002 |pmid=12415587 |doi= |url=}}</ref>


=== Study of choice ===
The 2010 new criteria rates on a scale from 0-10 points  are assigned in four separate domains of signs and symptoms:
*Anti-CCP antibodies testing is the gold standard test for the diagnosis of [[rheumatoid arthritis]].
* The following result of [gold standard test] is confirmatory of [disease name]:
** Result 1
** Result 2
* The [name of the investigation] should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison of various diagnostic studies for [disease name] ====
1) [[Joint]] involvement
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>


===== Diagnostic results =====
2) [[Serology]]  
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2


===== Sequence of Diagnostic Studies =====
3) Duration of [[symptoms]]
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.


=== Diagnostic Criteria ===
4) Acute phase reactants
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].


* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
Patients are defined as having definite [[Rheumatoid arthritis|RA]] if there are the score of 6 or more points according to the following criteria
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].


* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
{| class="wikitable"
** Criteria 1
! colspan="4" |The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis.
** Criteria 2
|-
** Criteria 3
|'''Domains'''
|'''Description'''
|'''Number'''
|'''Score'''
|-
| rowspan="4" |[[Joint]] Involvement
| rowspan="2" |Median-large [[joint]]<sup>*</sup>
|2-10
|1
|-
|1-3
|2
|-
| rowspan="2" |Small [[joints]]<sup>**</sup>
|4-10
|3
|-
|>10<sup>***</sup>
|5
|-
| rowspan="3" |[[Serology]]
|No positive for either [[RF]] or anti-[[CCP]]
|
|0
|-
|At least one of these test positive at the high titer
|
|2
|-
|At least one of these test positive at low titer
|
|3
|-
|Duration of [[synovitis]]
| +/> six weeks
|
|1
|-
| rowspan="2" |Acute phase reactants
|Neither [[CRP]] or [[Erythrocyte sedimentation rate|ESR]] is abnormal
|
|0
|-
|Abnormal [[CRP]] or [[ESR]]
|
|1
|-
| colspan="4" |
<nowiki>*</nowiki>Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment.
<nowiki>*</nowiki>Shoulder, elbow, knee, ankle


IF there are clear, established diagnostic criteria:
<nowiki>**</nowiki> Small joints refer to metacarpophalangeal, proximal interphalangeal, second through 5th metatarsophalangeal, thumb interphalangeal and wrist joints
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


<nowiki>***</nowiki> In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large, additional small joint. Joints such as temporomandibular, acromioclavicular, and sternoclavicular joints may also be involved.
|}


==References==
==References==

Latest revision as of 20:52, 20 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Anti-CCP antibodies testing is the gold standard test for the diagnosis of rheumatoid arthritis. It has the specificity of about 81-100%, with the sensitivity of 39–94%.

Diagnostic Study of Choice

  • Anti-CCP antibodies testing is the gold standard test for the diagnosis of rheumatoid arthritis.[1][2]
    • It has the specificity of about 81-100%, with the sensitivity of 39–94%.

Diagnostic Criteria

The 2010 American College of Rheumatology classification criteria for diagnosis of rheumatoid arthritis:[3][4]

The 2010 new criteria rates on a scale from 0-10 points are assigned in four separate domains of signs and symptoms:

1) Joint involvement

2) Serology

3) Duration of symptoms

4) Acute phase reactants

Patients are defined as having definite RA if there are the score of 6 or more points according to the following criteria

The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis.
Domains Description Number Score
Joint Involvement Median-large joint* 2-10 1
1-3 2
Small joints** 4-10 3
>10*** 5
Serology No positive for either RF or anti-CCP 0
At least one of these test positive at the high titer 2
At least one of these test positive at low titer 3
Duration of synovitis +/> six weeks 1
Acute phase reactants Neither CRP or ESR is abnormal 0
Abnormal CRP or ESR 1

*Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment. *Shoulder, elbow, knee, ankle

** Small joints refer to metacarpophalangeal, proximal interphalangeal, second through 5th metatarsophalangeal, thumb interphalangeal and wrist joints

*** In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large, additional small joint. Joints such as temporomandibular, acromioclavicular, and sternoclavicular joints may also be involved.

References

  1. ↑ van Venrooij WJ, Hazes JM, Visser H (November 2002). "Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis". Neth J Med. 60 (10): 383–8. PMID 12607587.
  2. ↑ Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC, van Venrooij WJ (January 2000). "The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide". Arthritis Rheum. 43 (1): 155–63. doi:10.1002/1529-0131(200001)43:1<155::AID-ANR20>3.0.CO;2-3. PMID 10643712.
  3. ↑ Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, 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, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (September 2010). "2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative". Arthritis Rheum. 62 (9): 2569–81. doi:10.1002/art.27584. PMID 20872595.
  4. ↑ Maksymowych WP, Suarez-Almazor ME, Buenviaje H, Cooper BL, Degeus C, Thompson M, Russell AS (November 2002). "HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis". J. Rheumatol. 29 (11): 2319–26. PMID 12415587.

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