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. 2022 Sep 22:14:187-194.
doi: 10.2147/OARRR.S372724. eCollection 2022.

Misdiagnosis of Rheumatoid Arthritis in a Long-Term Cohort of Early Arthritis Based on the ACR-1987 Classification Criteria

Monica Leu Agelii  1 , Ingiäld Hafström  2 , Björn Svensson  3 , Sofia Ajeganova  4   5 , Kristina Forslind  3   5 , Maria Andersson  3   5 , Inger Gjertsson  1
Affiliations

Misdiagnosis of Rheumatoid Arthritis in a Long-Term Cohort of Early Arthritis Based on the ACR-1987 Classification Criteria

Monica Leu Agelii et al. Open Access Rheumatol. .

Abstract

Objective: Correct diagnosis of early rheumatoid arthritis (RA) is essential for optimal treatment choices. No pathognomonic test is available, and diagnosis is based on classification criteria, which can result in misdiagnosis. Here, we examined the differences between actual and misdiagnosed RA cases in a long-term cohort of patients included based on the ACR-1987 classification criteria.

Methods: Patients in the BARFOT (Better Anti-Rheumatic PharmacOTherapy) cohort (n=2543) with at least four follow-up visits during the initial 5 years from enrolment were assessed, and a change in diagnosis was reported by the treating rheumatologist. The groups were analysed with respect to the individual classification criteria, antibodies to citrullinated proteins (ACPA), disease activity (DAS28) and radiographic changes from inclusion up to 2 years.

Results: Forty-five patients (1.8%) were misdiagnosed (RA-change group). When compared to those in the RA-change group, the patients who kept their diagnosis (RA-keep) were more often RF positive (64% vs 21%, p<0.001) or ACPA positive (59% vs 8%, p<0.001). They were also more likely to fulfil more than four ACR-1987 criteria (64% vs 33%, p<0.001) and to have radiographic changes at inclusion (RA-keep 27% vs RA-change 12%, p=0.04). The groups had a similar evolution of DAS28 and its components as well as of radiological joint destruction.

Conclusion: Diagnosis of RA according to the ACR-1987 criteria had a high precision in this long-term cohort. A diagnosis of RA should be re-evaluated in patients who do not fulfil more than four ACR-1987 criteria especially in patients negative for RF.

Keywords: ACPA; ACR-1987 classification criteria; arthritis; precision; rheumatoid factor.

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Conflict of interest statement

Professor Inger Gjertsson reports personal fees from Socialstyrelsen, personal fees from internetmedicin.se, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of ACR-1987 criteria, and fulfilment of 5–7 criteria, for RA-change group (grey bar) and RA-keep (black bar). P-values given according to the Chi-square test.
Figure 2
Figure 2
Percentage of patients in the study over time for the RA-change (bottom line) and RA-keep (top line) groups, assessed by Kaplan–Meier curves and p-value given according to the Log rank test.
Figure 3
Figure 3
Median value for DAS28 together with its components (A–E), and VAS pain (F) over 2 years of follow-up. Median value for total radiological score (mSHS) (G) and its components joint space narrowing (JSN) (H) and erosion score (ES) (I) over 2 years of follow-up. RA-change group: grey line, RA-keep group: black line.
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