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Ability of Foot Radiographs to Predict Rheumatoid Arthritis in Patients with Early Arthritis
VALÉRIE DEVAUCHELLE PENSEC, ALAIN SARAUX, JEAN M. BERTHELOT, SABINE ALAPETITE, SANDRINE JOUSSE, CATHERINE Le HENAFF, GÉRARD CHALES, JEAN B. THOREL, SYLVIE HOANG, ISABELLE NOUY-TROLLE, ANTOINE MARTIN, GILLES CHIOCCHIA, PIERRE YOUINOU, and PAUL Le GOFF
ABSTRACT.
Methods. A cohort of patients with arthritis of less than one year duration was evaluated in a multicenter study and followed for 30 ± 11 months. An observer blinded to patient data read all 149 hand and foot radiographs done at study inclusion, using item 7 of the 1987 American College of Rheumatology (ACR) criteria for RA and Sharp's method to score erosions and joint space narrowing. Results. The kappa coefficient for the 1987 ACR item 7 was 0.52 for bony decalcification and 0.87 for erosions. Intra and interobserver correlation coefficients for Sharp's scores ranged from 0.90 to 0.98. Erosions at the feet were significantly associated with RA. The item 7 erosion component at the feet was more specific than the full item 7 (97.5% vs 94%; p = 0.01). Sharp's erosion score at the feet was not better than the erosion component of item 7 (sensitivity 18%; specificity 97.5%). Combined use of radiographs of the hands and feet improved the diagnostic performance of the item 7 erosion component; (sensitivity and specificity of item 7 erosions at the hands combined with the feet were 32.5% and 94.5%, respectively). Conclusion. The "erosion" criterion at the feet had the best diagnostic performance and was significantly associated with a diagnosis of RA. Combining hand and foot radiographs improved diagnostic performance. (J Rheumatol 2004;31:66-70) Key Indexing Terms:
RECENT ONSET ARTHRITIS
From the Unit of Rheumatology and the Laboratory of Immunology, Hôpital de la Cavale Blanche, CHU Brest, Brest; Department of Rheumatology, Hôtel-Dieu, CHU Nantes, Nantes; and the Departments of Rheumatology of Rennes, Morlaix, Lorient, and Vannes, and the Department of Immunology, Institut Cochin Inserm U567 CNRS UMR 8104 IFR116, Paris, France. Supported by the Brest Hospital Center and the 1995 Clinical Research Hospital Program (PHRC 1995). V. Devauchelle Pensec, MD; A. Saraux, MD, PhD; S. Alapetite, MD; S. Jousse, MD; P. Youinou, MD, PhD; P. Le Goff, MD, Unit of Rheumatology and Laboratory of Immunology, Hôpital de la Cavale Blanche; J.M. Berthelot, MD, Department of Rheumatology, Hôtel-Dieu, CHU Nantes; G. Chales, MD, Department of Rheumatology, CHU Rennes; C. Le Henaff, MD, Department of Rheumatology, Morlaix; J.B. Thorel, MD, Department of Rheumatology, Lorient; S. Hoang, MD, Department of Rheumatology, CHR Vannes; I. Nouy-Trolle, MD, Department of Rheumatology, CHR Quimper; A. Martin, MD, Department of Rheumatology, CHR St. Brieuc; G. Chiocchia, PhD, Institut Cochin INSERM U567 CNRS UMR 8104 IFR116, Paris. Address reprint requests to Prof. A. Saraux, Unit of Rheumatology, Hôpital de la Cavale Blanche, BP 824, F29609 Brest cedex, France. E-mail: alain.saraux@univ-brest.fr Submitted December 30, 2002; revision accepted June 9, 2003. |