SpA was defined by the criteria of the European Spondylarthropathy Study Group in 1991. The full article was not able to be accessed, but the material I have found is from the abstract of the original article. "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."
RA was defined by the criteria according to the American College of Rheumatology, formerly known as the American Rheumatism Association. This criteria was also published years prior to the publishing of the article discussed in class. The definition of RA, according to "The American Rheumatism Association 1987 Revised Criteria For The Classification of Rheumatoid Arthritis," is as follows: "1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3)swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid facto; and 7) radiographic erosions and/or periarticular osteopenia in hands and/or wrist joints. Criteria 1 through 4 must be present for 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or lists of exclusions are required."
OA was also defined by ACR criteria, though from 1986. The data was put into a table and put into three categories: Clinical and Laboratory, Clinical and Radiographic, and Clinical t.
Under Clinical and Laboratory criteria, knee pain and at least 5 of 9 criteria must be met: age > 50, stiffness < 30 minutes, crepitus, bony tenderness, bony enlargement, no palpable warmth, erythrocyte sedimentation rate (ESR) < 40 mm/hour, rheumatoid factor (RF) < 1:40, and synovial fluid signs of osteoarthritis (SF OA).
Under Clinical and Radiographic criteria, knee pain and at least 1 of 3 criteria must be met: age > 50, stiffness < 30 minutes, and crepitus + osteophytes.
Under Clinical t criteria, knee pain and at least 3 of 6 criteria must be met: age > 50, stiffness < 30 minutes, crepitus, bony tenderness, bony enlargement, and no palpable warmth.
I find it strange that a scientific article submitted in 2007 is using criterion published in 1986, 1988, and 1991, while there is much more recently published criteria for OA, RA, and SpA available. Anyone have any thoughts?
Resources:
1. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification
of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
Arthritis Rheum 1986;29(8):1039-49.
2. Arnett FC, Edworthy SM, Bloch DA, et. al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315-24.
3. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, Cats A, Dijkmans B, Olivieri I, Pasero G. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34:1218-1227.
This is a good point, but I wonder if the definitions of these have changed much recently. I tried looking up recent new definitions for these and most of them are along the same lines, however I couldn't find a concrete one so maybe I am wrong. Sometimes the definitions don't change much for years because there are no new ways or findings to add to them. If this is the case then I think the article is okay in using them, but there was a more recent and different definition for these than the ones they used then I think it could change how they analyze their results a little bit. I will keep looking for some concrete recent definitions!
ReplyDeleteI agree with NSisterna. I looked around for newer or changed definitions but couldn't find anything that was very different from the ones used in your article. I think that it really is just because the disease(s) and symptoms that characterize them just haven't changed substantially since they were first made. That makes sense, though, because a lot of the diseases that we have today are characterized based on criteria that were found decades ago when the diseases themselves were discovered. Some diseases are named after the people who discovered them, who are long dead. I think that the criteria for most diseases is pretty stable. There will always be small differences from one patient to the next, so it is then up to the diagnosing physician to see if their patient is exhibiting symptoms that fit the definition of condition "A" or condition "B" better. For the most part, I think that it is acceptable for older criteria to be used if nothing much has changed.
ReplyDeleteI also agree with bot of you. I don't think there is any harm in using the older article as reference. If there hasn't been much change from the research that has been done previously than the most recent ones. If the new research results are similar to the old ones,i think it is okay to use the old articles. Unless the new articles shines the light on the new findings on the particular research we can assume that the new article is based on the old ones so instead of going to the new article we can just go the old articles for credibility. But before using it as a criterion these studies should be evaluated for their relevance and strength of evidence.
ReplyDeleteI think that the fact that no new evidence has come to contradict this old study adds to the credibility of the study. I'll problably contradict myself now, but it could also just be that no one wanted to conduct further studies on that area.
ReplyDeleteHi Guys,
ReplyDeleteThe American College of Rheumatology (ACR) came out with new classification criteria for rheumatoid arthritis (RA) in 2010. The reason for the new ACR 2010 criteria was that the old 1987 criteria you mentioned was targeted more at people with late-stage RA and terrible at catching people with early clinical RA. The new 2010 criteria focuses on features of early RA and is much better at diagnosing people early on.
I'm not sure about the details of the study you are referring to, but just based on the title, I can take an educated guess at why they would want to use older criteria. My best guess is that the ACR 2010 criteria were not out in 2007 :) To answer the more relevant question on why you'd use older criteria in a study when new criteria are available, my first guess would be that the researchers wanted to reduced misclassification of disease in the study. You would want to make sure you are really studying persons with RA and not some other form of arthritis or even someone that thinks they have RA because they have a sore joint. We would do this to minimize the chance of misclassifying RA, which reduces bias and increases the validity of your study. For RA, 1987 classified RA patients have a later stage of the disease and are more likely have more inflammation and thus more measurable cytokines.
My second guess as to why you'd use an older criteria when a newer one is available is that patient data (blood, medical Dx)might have been collected in the past before the new criteria was widely used. These data are still very valuable and you might need to use the criteria with which they were diagnosed with at the time.
Here is the new ACR 2010 criteria. I'm guessing you can also find the other diseases on the ACR website as well.
http://www.rheumatology.org/practice/clinical/classification/ra/2010_revised_criteria_classification_ra.pdf