Ability of the American College of Rheumatology 1987 criteria to predict rheumatoid arthritis in patients with early arthritis and classification of these patients two years later.

OBJECTIVE: To determine how well the American College of Rheumatology (ACR; formerly, the American Rheumatism Association) 1987 classification criteria for rheumatoid arthritis (RA), when used at study inclusion in a cohort of 270 patients with early (<1 year) arthritis, predicted a diagnosis of RA 2 years later and how well they classified these patients at the end of the 2 years. METHODS: Patients were evaluated during 1995-1997 at 7 hospitals in the Brittany region of France. Patients were evaluated at 6-month intervals until November 1999. The diagnosis made by a panel of 5 rheumatologists (P5R) after the last visit was used as the "gold standard." The ACR 1987 criteria for RA were applied prospectively, without taking into account the initial diagnosis. RESULTS: At the last visit (mean +/- SD followup 29.1 +/- 11.8 months; median 30 months), the P5R diagnosed RA in 98 patients. At the last visit, classification by the ACR criteria was satisfactory, and the combination of an office-based rheumatologist's (OBR's) diagnosis of RA and fulfillment of the ACR criteria was sensitive (87%; 85 of 98 RA patients had both) and highly specific (99%; 170 of 172 non-RA patients did not have both). Application of the criteria at the first visit was of limited value for predicting a diagnosis of RA 2 years later. CONCLUSION: After a 2-year followup, the ACR 1987 classification criteria used in combination with an OBR's diagnosis were effective in distinguishing patients with and without RA. The criteria were not useful for predicting RA in patients with arthritis onset within the previous year. Some patients who met the criteria at baseline and after 2 years did not have RA, suggesting that incorporating exclusion criteria may improve the performance of the ACR criteria when used without taking into account the diagnosis by a rheumatologist, particularly in early arthritis.

Ability of hand radiographs to predict a further diagnosis of rheumatoid arthritis in patients with early arthritis.

OBJECTIVE: To evaluate the ability of hand radiographs collected at study inclusion to predict a diagnosis of rheumatoid arthritis (RA) 2 years later, in a cohort of patients with early arthritis. METHODS: We evaluated 270 patients with arthritis of less than one year duration. At the first visit, all patients underwent a standardized evaluation including laboratory tests and radiographs. Followup was 30+/-11.3 mo. The hand radiographs were read by observers blinded to patient data who looked for item 7 of the 1987 ACR criteria for RA and used Sharp's method to score erosions and joint space narrowing. RESULTS: The kappa coefficient for ACR item 7 was < 0.65 for bony decalcification and > 0.8 for erosions. Intra and interobserver correlation coefficients for Sharp score ranged from 0.90 to 0.95. The "erosion" component of ACR item 7 was more specific than the full item 7 (96% versus 87.5%; p = 0.02). Sharp erosion score was not better than the erosion component of item 7 (sensitivity 17%; specificity 96%). CONCLUSION: Regardless of the criterion used, hand radiographs were of limited value to predict which patients would be considered as having RA 2 years later. Diagnostic performance was similar for the "erosions" component of the 1987 ACR item 7 and for Sharp erosion score. The full 1987 ACR item 7 (erosions or bony decalcification) performed less well.

[Decrease of the functional affinity of rheumatoid factors under the effect of tiopronin]. / Réduction de l'affinité fonctionnelle des facteurs rhumatoïdes sous l'effet de la tiopronine.

Sixteen rheumatoid arthritis patients were serologically examined, before and after a 2-month treatment with tiopronine (TP). The titer of agglutinating rheumatoid factor (RF) as well as the level of non-agglutinating RF were significantly reduced in serum and synovial fluid (SF). The functional affinity of the remaining RF was attenuated in serum (p less than 0.01) and SF (p less than 0.05). Conversely, the proportion of asialylated IgG was enhanced in serum (p less than 0.05) and SF (p less than 0.05). These findings would suggest that TP might restore the efficacity of sialyl transferase at the B lymphocyte level.

[Acute cotrimoxazole-induced thrombocytopenia, facilitating role of phenobarbital (author's transl)]. / Thrombopénie aiguë au cortrimoxazole. Rôle facilitant du phénobarbital.

A fifty-year-old-woman treated by phenobarbital for seven months developed an acute thrombocytopenia while taking cotrimoxazole for eight days, because of urinary tract infection. The antifolic effect of these two drugs may be increased when they are taken together, and then may be the cause of hematologic disorders. Therefore the authors think these two drugs must not be given together.

[Primary biliary cirrhosis as seen by the rheumatologist. Apropos of 2 cases]. / La cirrhose biliaire primitive vue par le rhumatologue. A propos de deux observations.

The authors report 2 cases of primary biliary cirrhosis associated with scleroderma (calcinosis, Raynaud's syndrome, sclerodactyly, telangiectasia) in one case, and associated with pseudopolyarthritis in the other; they recall the conditions under which the rheumatologist may be led to make the diagnosis of this disease. Apart from liver diseases including acute or chronic rheumatic signs, one may observe in primary biliary cirrhosis without symptoms certain other rheumatological syndromes: e.g. scleroderma, Sjögren's syndrome, rheumatoid arthritis, Charcot's joint. The laboratory examinations may give unexpected results: e.g. high levels of IgM, the presence of antinuclear antibodies or may give unexpected results: e.g. high levels of IgM, the presence of antinuclear antibodies or cryoglobulins which sometimes orient wrongly the diagnosis in other directions. One may thus note that a high level of alkaline phosphatase should suggest in any case of inflammatory rheumatism, primary biliary cirrhosis, and attempt to prove this by seeking antimitochondrial antibodies.

[Lumbar phelbography without catheterization. Technic, indications and results in the diagnosis of intervertebral disk herniation]. / La phlébographie lombaire sans cathétérisme. Technique, indications, résultats dans le diagnostic de la hernie discale.

The authors present a new method of lumbar phlebology without catheterism by direct venous puncture of the femoral veins. An analysis of 300 contrast tests maked it possible to identify different types of pathological images characterized by disappearance and displacement of epidural veins corresponding as a rule to discal hernia when the uncharacteristic shadowy images do not allow one to make a precise conclusion or to determine whether an operation is needed. With equal reliability (96 percent), lumbar phlebography without catheterism is, by its simplicity and harmlessness and the absence of minor and major venous complications, preferable to phlebography by catheterism. Carried out in all subjects, whatever their age, without special precautions, it seems to us to now be the most desirable test to be used in the radiological investigation of lumbar discal hernias.

[Study of a population carrying HLA B27 antigen compared with a population without B27, in the detection of ankylosing spondylitis]. / Etude d'une population porteuse de l'antigéne HLA B27 comparée a celle d'une population témoin non B27 á la recherche de la spondylarthrite ankylosante.

Comparative study of 2 groups matched for age and sex, 39 subjects with B 27 and 40 subjects without B 27, chosen at random from blood donors, leads to the conclusion that the former complain of chronic low back pain and joint manifestations, and show a reduction in the range of movement of the lumbar spine, significantly more frequently than the latter. While radiological abnormalities of the sacro-iliac joints considered individually do not permit separation of those bearing the antigen from the controle, grouping them together shows that there are more cases of stage III sacro-ilitis among those with B 27. In all, 5 cases of spondylitis defined according to the New York criteria were found in this way in the group with B 27, 12.8 per cent as against 3 per cent in the controls. From these results, the incidence of rheumatic spondylitis can be estimated as between 0.8 and 1.7 per cent.