Do We Need to Lower the Cut Point of the 2010 ACR/EULAR Classification Criteria for Diagnosing Rheumatoid Arthritis?
van der Ven M, Alves C, Luime JJ, et al Rheumatology (Oxford). 2016;55:636-639
Study Summary
Using a cohort of 557 patients from an early arthritis clinic in Rotterdam, The Netherlands, van der Ven and colleagues evaluated the effect of lowering the established cut-off from 6 points to 5 points for diagnosing rheumatoid arthritis (RA) using the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria.
After 1 year of follow-up, 253 (45%) of the patients were classified as "cases," defined as having been put on methotrexate for RA. At the baseline visit, the sensitivity for a cut-off point of a score of ≥6 was 61%, with a specificity of 76%. With a cut point of ≥5, the sensitivity increased to 76%, and the specificity decreased to 68%.
The authors concluded that lowering the cut-off of the 2010 criteria from 6 points to 5 points identified 15% more patients with RA, at the expense of including 8% false-positive patients.
Viewpoint
As wonderfully discussed in a recent review by Aggarwal and other members of the ACR's Subcommittee on Classification and Response Criteria,[1]the use of "classification" and "diagnostic" criteria in rheumatic diseases is complex. Classification criteria are primarily designed for research in order to ensure that the patients studied are homogenous.
