[658] - Application of the New ACR/EULAR Classification
Criteria for Rheumatoid Arthritis to At-Risk Populations May
Identify RA Prior to Clinical
Presentation.
Jason R
Kolfenbach, MD 1,Lezlie Derber2,Kevin D Deane,
MD3,Jan Hughes-Austin4,Michael H Weisman,
MD5,Jane Buckner6,Ted R Mikuls,
MD7,James R O'Dell, MD8,Peter K Gregersen,
MD9,Richard M Keating,Jill Norris, MPH,
PhD10,V Michael Holers, MD11.
1Division of Rheumatology, University of Colorado
Denver, Aurora, CO,2Division of Rheumatology, University
of Colorado Denver,3Division of Rheumatology, Division
of Rheumatology, University of Colorado Denver, Aurora,
CO,4Department of Epidemiology, Colorado School of
Public Health, University of Colorado
Denver,5Rheumatology, Cedars Sinai Medical Center, Los
Angeles, CA,64Benaroya Research Institute at Virginia
Mason,7Internal Medicine, University of Nebraska Medical
Center, Omaha, NE,8Department of Internal Medicine,
University of Nebraska Medical Center, Omaha,
NE,9Biology & Human Genetics, N Shore
Univ Hosp Rsch Ctr, Manhasset,
NY,10,11Epidemiology, University of Colorado
Denver, Aurora, CO,12Rheumatology Division, University
of Colorado School of Medicine, Aurora, CO
Objective: The proposed ACR/EULAR classification criteria were
developed in part to identify early RA. Applying the new criteria
to at-risk populations prior to evaluation in the health care
setting may identify a unique cohort in which to study the
evolution of very early symptomatic RA. We have established
prospective cohorts of subjects at potentially higher risk for RA
based on genetic risk factors as part of the SERA study
(Studies of the Etiology of RA). The purpose
of the current analysis was to identify and characterize a cohort
within these populations with 'definite RA' according to the newly
proposed criteria.
Methods: We have established a cohort of first-degree
relatives (FDRs) of probands with RA. FDRs without RA by the 1987
ACR criteria undergo a joint exam and have laboratory data
obtained. Identical data is collected on a second at-risk
DR4-enriched population containing parents of children with high
risk HLA alleles and/or Type I diabetes. The proposed RA criteria
were applied to subjects in these cohorts with swelling suggestive
of synovitis in ≥ 1 joint on clinical exam after exclusion of
findings attributed to alternative diagnoses (e.g. trauma,
osteoarthritis). Data regarding joint distribution, duration of
symptoms, antibody status and presence of elevated inflammatory
markers were used to apply the new criteria. Descriptive statistics
were calculated for the identified cases.
Results: 1790 subjects were available for analysis. 153
subjects (8.5%) had synovitis in ≥ 1 joint on clinical exam. 21
subjects (1.17%) had 'definite RA' according to the proposed
algorithm. 17/21 (81%) subjects were female with a mean age of 48.9
years old. 6/21 subjects (28.6%) were positive for rheumatoid
factor (RF), one (4.8%) was positive for anti-cyclic citrullinated
peptide antibody, and 11 (52.4%) had elevated levels of CRP. Median
swollen and tender joint counts were 3 and 11, respectively. The
average total score in the 21 subjects was 6.76. The mean scores
for joint involvement, serology, acute phase reactant and duration
were 4.33, 0.9, 0.52 and 1.0, respectively (Table
1).
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在高风险人群中应用新版RA分类标准可能发现更多临床前RA
Kolfenbach JR, et al. ACR 2010. Present No:
658.
目的:制订新的ACR/EULAR分类标准的一个原因是为了发现早期RA。在高风险人群中应用新标准可能可以发现一个特殊群体,以研究极早期有症状的RA的演变。我们根据SERA研究(Studies of the Etiology of
RA)中的遗传危险因素,将RA潜在高风险的个体组成前瞻性队列。本研究旨在根据新建议的标准,在这些人群中发现“明确的RA”,并明确其特征。
方法:我们建立了一个RA患者一级亲属(FDRs)的队列。根据1987年ACR标准,对不符合RA诊断的FDRs进行关节检查,并采集其实验室资料。另一个队列纳入DR4阳性的高危人群,包括含有高危HLA等位基因和/或1型糖尿病儿童的父母。通过临床检查,在这些队列中挑选出有一个以上关节肿胀(提示滑膜炎)、排除其它诊断(如创伤、骨关节炎)的个体,对其应用新版RA分类标准。根据新标准,采集关节分布、症状持续时间、自身抗体、升高的炎性指标等数据。对这些病例进行描述性统计分析。
结果:共有1790人纳入分析。153例(8.5%)在临床检查中有一个以上关节滑膜炎。根据新建议标准,21例(1.17%)为“明确的RA”。
17/21例(81%)为女性,平均年龄48.9岁。6/21例(28.6%)RF阳性,1例(4.8%)抗CCP抗体阳性,11例(52.4%)CRP升高。平均肿胀关节数和压痛关节数分别为3和11。21人的平均总积分为6.76。关节受累、血清学、急性期反应物和病程的平均积分分别为4.33、0.9、0.52和1.0(表1)。
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