Toward a data-driven evaluation of the 2010 American College of Rheumatology/European League Against Rheumatism criteria for rheumatoid arthritis: Is it sensible to look at levels of rheumatoid factor?
Article first published online: 27 APR 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 5, pages 1190–1199, May 2011
How to Cite
van der Linden, M. P. M., Batstra, M. R., Bakker-Jonges, L. E., Foundation for Quality Medical Laboratory Diagnostics, Detert, J., Bastian, H., Scherer, H. U., Toes, R. E. M., Burmester, G.-R., Mjaavatten, M. D., Kvien, T. K., Huizinga, T. W. J. and van der Helm-van Mil, A. H. M. (2011), Toward a data-driven evaluation of the 2010 American College of Rheumatology/European League Against Rheumatism criteria for rheumatoid arthritis: Is it sensible to look at levels of rheumatoid factor?. Arthritis & Rheumatism, 63: 1190–1199. doi: 10.1002/art.30200
- Issue published online: 27 APR 2011
- Article first published online: 27 APR 2011
- Accepted manuscript online: 15 DEC 2010 11:54AM EST
- Manuscript Accepted: 7 DEC 2010
- Manuscript Received: 29 NOV 2010
- NWO-ZonMW VIDI and VICI grant from the Netherlands Organization for Scientific Research
- Dutch Arthritis Foundation
- European Union Sixth Framework Programme project AutoCure and Seventh Framework Programme project Masterswitch. Grant Number: HEALTH-F2-2008-223404
- Netherlands Organization for Health Research and Development
- Dutch Arthritis Association
Recently, new classification criteria for rheumatoid arthritis (RA) have been devised by methodology that used first a quantitative approach (data from databases), then a qualitative approach (consensus; based on paper patients), and finally a common sense–based approach (evaluation of the former phases). Now the individual items that make up these criteria are being evaluated. This study was undertaken to analyze the item “autoantibodies,” in particular rheumatoid factor (RF) level.
Three separate cohorts comprising a total of 972 patients with undifferentiated arthritis were studied for RA development (according to the 1987 American College of Rheumatology criteria) and arthritis persistence. The positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) were compared between different levels of RF and the presence of anti–citrullinated protein antibody (ACPA). A similar comparison was made in 686 RA patients for the rate of joint destruction and achievement of sustained disease-modifying antirheumatic drug–free remission during 7 years of followup. The variation in RF levels obtained by different measurement methods in the same RF-positive sera was explored.
Compared to high RF levels, presence of ACPA had a better balance between positive LR and negative LR and between PPV and NPV for RA development. The additive value of ACPA assessment after testing for RF level was higher than vice versa. The association between high RF level and RA severity was not as strong as that between ACPA antibodies and RA severity. The RF level obtained by different methods in the same patients' sera varied considerably.
Our findings indicate that determination of RF level is subject to large variation; high RF level has limited additive prognostic value compared to ACPA positivity. Thus, omitting RF level and using RF presence, ACPA presence, and ACPA level may improve the 2010 criteria for RA.