Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria.
TL;DR: The study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice, and substitution of the Rome pain criterion for the New York pain criterion is proposed.
Abstract: The New York and the Rome diagnostic criteria for ankylosing spondylitis (AS) and the clinical history screening test for AS were evaluated in relatives of AS patients and in population control subjects. The New York criterion of pain in the (dorso) lumbar spine lacks specificity, and the chest expansion criterion is too insensitive. The Rome criterion of low back pain for more than 3 months is very useful. Our study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice. As a modification of the New York criteria, substitution of the Rome pain criterion for the New York pain criterion is proposed.
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TL;DR: In this article, a process of standardizing the methods for reporting clinical data in the field of uveitis has been discussed, and the results used to develop a series of proposals to better standardize the use of these entities.
3,283 citations
Charité1, Leiden University2, Maastricht University3, Dokuz Eylül University4, Ruhr University Bochum5, University of Córdoba (Spain)6, University of Paris7, Sun Yat-sen University8, Ege University9, University of Alberta10, Ghent University11, University of Copenhagen12, Fırat University13, Barking, Havering and Redbridge University Hospitals NHS Trust14, Chung Shan Medical University15
TL;DR: The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial spondyloarthritis in those with chronic back pain.
Abstract: Objective: To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA). Methods: All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients with chronic (⩾3 months) back pain of unknown origin that began before 45 years of age. The candidate criteria were first tested in the entire cohort of 649 patients from 25 centres, and then refined in a random selection of 40% of cases and thereafter validated in the remaining 60%. Results: Upon diagnostic work-up, axial SpA was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New York criteria and, therefore, were classified as having “non-radiographic” axial SpA. Refinement of the candidate criteria resulted in new ASAS classification criteria that are defined as: the presence of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at least one SpA feature (“imaging arm”) or the presence of HLA-B27 plus at least two SpA features (“clinical arm”). The sensitivity and specificity of the entire set of the new criteria were 82.9% and 84.4%, and for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and slightly better than that of the modified Amor criteria (sensitivity 82.9, specificity 77.5%). Conclusion: The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial SpA in those with chronic back pain. Trial registration number: NCT00328068.
2,704 citations
Centers for Disease Control and Prevention1, University of Texas Health Science Center at Houston2, University of Washington3, Boston University4, Boston Children's Hospital5, National Institutes of Health6, University of Maryland, Baltimore7, Mayo Clinic8, Brigham and Women's Hospital9, Georgetown University Medical Center10
TL;DR: Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.
Abstract: Objective
To provide a single source for the best available estimates of the national prevalence of arthritis in general and of selected musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, the spondylarthropathies, systemic lupus erythematosus, scleroderma, polymyalgia rheumatica/giant cell arteritis, gout, fibromyalgia, and low back pain).
Methods
The National Arthritis Data Workgroup reviewed data from available surveys, such as the National Health and Nutrition Examination Survey series. For overall national estimates, we used surveys based on representative samples. Because data based on national population samples are unavailable for most specific musculoskeletal conditions, we derived data from various smaller survey samples from defined populations. Prevalence estimates from these surveys were linked to 1990 US Bureau of the Census population data to calculate national estimates. We also estimated the expected frequency of arthritis in the year 2020.
Results
Current national estimates are provided, with important caveats regarding their interpretation, for self-reported arthritis and selected conditions. An estimated 15% (40 million) of Americans had some form or arthritis in 1995. By the year 2020, an estimated 18.2% (59.4 million) will be affected.
Conclusion
Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.
2,667 citations
TL;DR: The proposed classification criteria for spondylarthropathy are easy to apply in clinical practice and performed well in all 7 participating centers and are regarded as preliminary until they have been further evaluated in other settings.
Abstract: Classification criteria for most of the disorders belonging to the spondylarthropathy group already exist. However, the spectrum of spondylarthropathy is wider than the sum of these disorders suggests. Seronegative oligoarthritis, dactylitis or polyarthritis of the lower extremities, heel pain due to enthesitis, and other undifferentiated cases of spondylarthropathy have been ignored in epidemiologic studies because of the inadequacy of existing criteria. In order to define classification criteria that also encompass patients with undifferentiated spondylarthropathy, we studied 403 patients with all forms of spondylarthropathy and 674 control patients with other rheumatic diseases. The diagnoses were based on the local clinical expert's opinion. The 403 patients included 168 with ankylosing spondylitis, 68 with psoriatic arthritis, 41 with reactive arthritis, 17 with inflammatory bowel disease and arthritis, and 109 with unclassified spondylarthropathy. Based on statistical analysis and clinical reasoning, we propose the following classification criteria for spondylarthropathy: inflammatory spinal pain or synovitis (asymmetric or predominantly in the lower limbs), together with at least 1 of the following: positive family history, psoriasis, inflammatory bowel disease, urethritis, or acute diarrhea, alternating buttock pain, enthesopathy, or sacroiliitis as determined from radiography of the pelvic region. These criteria resulted in a sensitivity of 87% and a specificity of 87%. The proposed classification criteria are easy to apply in clinical practice and performed well in all 7 participating centers. However, we regard them as preliminary until they have been further evaluated in other settings.
2,164 citations
DOI•
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05 Nov 2009
TL;DR: 结节病易误诊,据王洪武等~([1])收集国内18篇关于此第一印象中拟诊 结核5例,为此应引起临床对本 病诊
Abstract: 结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。
1,821 citations
References
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TL;DR: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification and showed gains in sensitivity and specificity.
Abstract: The 1971 preliminary criteria for the classification of systemic lupus erythematosus (SLE) were revised and updated to incorporate new immunologic knowledge and improve disease classification. The 1982 revised criteria include fluorescence antinuclear antibody and antibody to native DNA and Sm antigen. Some criteria involving the same organ systems were aggregated into single criteria. Raynaud's phenomenon and alopecia were not included in the 1982 revised criteria because of low sensitivity and specificity. The new criteria were 96% sensitive and 96% specific when tested with SLE and control patient data gathered from 18 participating clinics. When compared with the 1971 criteria, the 1982 revised criteria showed gains in sensitivity and specificity.
14,272 citations
TL;DR: A multicenter, ongoing study of early-diagnosed cases of systemic sclerosis and comparison patients with systemic lupus erythematosus, polymyositis/dermatomyositis, and Raynaud's phenomenon was conducted in order to develop classification criteria for systemic sclerosis.
Abstract: A multicenter, ongoing study of early-diagnosed cases of systemic sclerosis and comparison patients with systemic lupus erythematosus, polymyositis/dermatomyositis, and Raynaud's phenomenon was conducted in order to develop classification criteria for systemic sclerosis. Preliminary criteria are proposed, namely, the finding of either the sole major criterion, i.e.,1) sclerodactyly, 2) digital pitting scars of fingertips or loss of substance of the distal finger pad, and 3) bilateral basilar pulmonary fibrosis. When applied to the case and comparison patients included in this study, these proposed criteria had a 97% sensitivity for definite systemic sclerosis and 98% specificity.
4,642 citations
TL;DR: A controlled study demonstrated that the clinical history may be sensitive and specific in the differential diagnosis of ankylosing spondylitis when reliance of five specific historic features is made.
Abstract: A controlled study of 138 subjects demonstrated that the clinical history may be sensitive (95%) and specific (85%) in the differential diagnosis of ankylosing spondylitis when reliance on five specific historic features is made. Back pain that is insidious in onset, in a patient younger than 40 years, persisting for at least three months, associated with morning stiffness and improving with exercise is characteristic of inflammatory spinal disease. (JAMA237:2613-2614, 1977)
596 citations
TL;DR: The human hand is a fascinating subject, an actor of many roles and disguises: the man in miniature, revealing its owner's story, here is a book which sets out to teach us how best to examine it and is disappointing because it is only 50 per cent of the classic it might have been
Abstract: The Hand as a Mfrror of Systemic Disease. By THEODORE J. BERRY. 1963. Pp. 215, 129 figs, bibl. F. A. Davis Company, Philadelphia; Blackwell, Oxford. (£6.) The human hand is a fascinating subject, an actor of many roles and disguises: the man in miniature, revealing its owner's story. Here is a book which sets out to teach us how best to examine it. This book has had an immediate appeal to everyone who has seen it. All doctors are, from time to time, called upon to see patients quickly, when facilities and time for a full general examination are missing. A guide to what could be regarded as \"how-not-to-miss-systemic-diseasewithout-undressing-the-patient\" will obviously have a wide market. The book is excellently printed, beautiully bound, and most of the pictures are clear and comprehensive. Something of the poetry of the hand gets into the text (and a few woolly paragraphs as well). One cannot fail to learn from the illustrations, and one will have the satisfaction of owning an attractive book. Because of the obviously wide appeal and need for a book of this sort, it has to be judged against high standards, and unfortunately, with such a magnificent subject, this book is disappointing because it is only 50 per cent. of the classic it might have been. In these days when almost every post brings drug company \"hand-outs\" illustrated by beautiful and exact colour pictures, it seems a shame that a teaching book like this should still rely on black and white illustrations, many of which are artistically indifferent. Probably this was inevitable on grounds of expense, but what might have been avoided is some careless editing, as in the passage which reads as though a functioning parathyroid adenoma was a cause of hypoparathyroidism and in another where a swelling of a finger joint in rheumatoid arthritis is referred to as a ganglion. The legend to Fig. 19 refers to two pictures of different rheumatoid hands as though they were from the same patient; a little scrutiny shows that one of these is a hand also illustrated over a different caption in Fig. 20, and almost certainly over yet another caption in Fig. 18. Sometimes the text carries imaginative and facile \"explanations\" of morbid changes. Thus, of arthritis mutilans: \" . . . Atrophy of the interossei muscles and of the thenar pad occurs from disuse and permits the overpull of unaffected muscles. Shortening of the fingers results . . .\". Clubbing of the fingers is ascribed to rouloux formation: \" . . . and therefore in diseases in which there is an increase in serumglobulin concentration and consequently exaggerated rouloux formation, the digits may exhibit clubbing . . .\". Of rheumatic fever: I . . . pocked and stippled nails have been observed in 95 per cent. of subjects with acute rheumatic fever and chorea. This is probably due to a nutritional defect . . .\" But if space is saved by such unqualified pronouncements it is as surely wasted in the reference list. There are no references in the body of the text, and the many references at the end of the book do not include titles, but are collected in groups under chapter headings. This makes it difficult to find out about any specific topic. The author has his own ideas as to what constitute the \"discollagenoses\", but the ioor reader, wanting to find out more about, say, osteo-arthritis (which is included under this heading) would have twenty untitled references to choose from, only one of which might be the germane. A. ST.J. DIXON.
533 citations
TL;DR: The discriminatory value of the New York criterion of history of pain or the presence of pain at the dorsolumbar junction or in the lumbar spine was analyzed in the population and family studies and was found to be too nonspecific.
Abstract: The present study was performed on 61 HLA-B27 positive first-degree relatives and 40 HLA-B27 negative relatives of 20 HLA-B27 positive probands with ankylosing spondylitis (AS). Of 24 HLA-B27 positive relatives 45 years or older, 21% had AS and 38% sacroiliitis. The HLA-B27 negative relatives did not have features of either disease. In the population study of 2,957 individuals 45 years or older, we found 5 cases of HLA-B27 positive sacroiliitis (according to the New York criteria) and 3 of these fulfilled the New York criteria for diagnosis of AS. In 2 of these 3 individuals, the diagnosis was made on clinical grounds. The phenotype frequency of HLA-B27 in this population is 7.8%, or about 230 HLA-B27 positive individuals in this population sample. Since AS was found in only 3 individuals, 1.3% of the HLA-B27 positive individuals in the population at large have AS; therefore, our data show that among individuals 45 years or older, 21% of HLA-B27 positive relatives of HLA-B27 positive AS patients have AS as compared with 1.3% of the HLA-B27 positive individuals in the population at large. Thus, the risk for AS is 16 times greater in the HLA-B27 positive relatives compared with HLA-B27 positive individuals in the population at large. The discriminatory value of the New York criterion of history of pain or the presence of pain at the dorsolumbar junction or in the lumbar spine was analyzed in the population and family studies and was found to be too nonspecific.
472 citations