Diagnosis of rheumatoid arthritis criteria

If PsA is not identified early and managed appropriately, progressive joint damage with deformities and disability may result. Diagnosis of rheumatoid arthritis criteria classification criteria have been proposed, but none have been widely accepted or validated. The CASPAR criteria permit the diagnosis of PsA in spite of low rheumatoid factor positivity.

They offer classification criteria that are simple and easy to use with a high degree of specificity and good sensitivity. PsA often is missed in primary care physicians’ and dermatologists’ offices. The quality of life in patients who have PsA is reported to be much worse than in those who have only psoriasis. The advent of effective new therapies, such as biologic agents, has made widely accepted and validated classification criteria imperative for PsA research trials to be meaningful. This is the fifth article in a series on new or modified classification and diagnostic criteria for various rheumatologic conditions.

ACR diagnostic criteria for fibromyalgia syndrome and their modification as survey criteria. In this article, we describe the classification criteria for PsA. The Moll and Wright Classification Criteria for PsA, proposed in 1973, are the oldest and best known. Several other classification criteria had been proposed over the years, but none have been widely accepted or validated. With the Moll and Wright criteria, patients who had cutaneous psoriasis and musculoskeletal involvement, such as dactylitis, enthesitis, and tendinitis, could not be classified as having PsA. The lack of universally accepted criteria had hampered clinical research in PsA—variability in case identification led to heterogeneous study populations, making interpretation and application of study results difficult. In addition, the exact prevalence of PsA had been difficult to estimate because accepted diagnostic and classification criteria were lacking.

2004 to develop a new set of validated classification criteria. Patients were consecutively enrolled from more than 30 rheumatology clinics in 13 countries—588 patients with PsA and 536 controls with other forms of inflammatory arthritis matched for approximate disease duration. Data were collected prospectively to compare existing classification criteria and derive new classification criteria for PsA. More than 50 variables were evaluated, including clinical, radiographic, and laboratory data.

These features were identified as being independently predictive of PsA and were used to create the new CASPAR criteria in 2006. The new CASPAR criteria had a sensitivity of 0. 914 and a specificity of 0. Several earlier classification criteria also were applied to the collected data. Although the sensitivity was slightly better with the Vasey and Espinoza method, the specificity is improved with the CASPAR criteria.

Many classification criteria have been proposed, but none were statistically derived from as large a prospective study as were the CASPAR criteria. The CASPAR criteria use some elements of the earlier criteria, but only those found to be independently predictive of PsA were included in the final set. Juxta-articular new bone formation was included as a feature of PsA in the CASPAR criteria but not in any previous criteria. The original diagnostic criteria of Moll and Wright probably are the simplest and the most frequently used in studies to date. RF, and an inflammatory arthritis in 1 of the 5 typical presentations for PsA. They were designed to be sensitive and not too specific, but this aspect may have led to misclassification of patients with seronegative RA and concurrent psoriasis as having PsA.

It also may have led to the exclusion of those who were seropositive for RF with PsA. The new CASPAR criteria permit the diagnosis of PsA in spite of low RF positivity. In addition, the inclusion of dactylitis and enthesitis has made possible the classification of a patient as having PsA in the absence of true arthritis. Also, because family history is included, the absence of psoriasis is permitted as long as other typical features of PsA are present.

The CASPAR criteria offer classification criteria that are simple and easy to use, with a high degree of specificity and good sensitivity. Classification and diagnostic criteria for psoriatic arthritis. Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Duarte GV, Faillace C, Freire de Carvalho J. Best Pract Res Clin Rheumatol.

Fournié B, Crognier L, Arnaud C, et al. Proposed classification criteria of psoriatic arthritis: a preliminary study in 260 patients. Gladman DD, Shuckett R, Russell ML, et al. Clinical application of the CASPAR criteria for psoriatic arthritis compared to other existing criteria. Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study.