Browsing by Author "Hallberg, Sophie"

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    How can we identify misdiagnosis in rheumatoid arthritis?
    (2022-05-23) Hallberg, Sophie; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
    Background: Rheumatoid arthritis (RA) is a common systemic autoimmune disease, with largely unknown pathogenesis, mainly affecting joints, leading to deformities with loss of function. The prevalence is 0.5 – 1.0 % in the general population. Diagnosis in an early stage of the disease is difficult but essential for suppressing inflammation and preventing damage and deformities in joints. As diagnosis criteria for RA are missing, the diagnosis is often established based on classification criteria. Objectives: This study examines differences between actual and misdiagnosed in a long-term cohort where patients were included based on the ACR1987 classification criteria for rheumatoid arthritis. Methods: Of the 2541 patients from the BARFOT (Better Anti Rheumatic Pharmaco Therapy) cohort, the RA diagnosis was changed in 44 patient (RA-change group). This group is compared patients who kept their RA (RA-keep group) during the follow-up time regarding (15 years for the majority of the patients). At inclusion all patients fulfilled the ACR 1987 classification criteria for RA. The two groups were compared regarding the number and type of classification criteria as well disease activity, medication, and radiographic changes. Results: Half of the RA-change group were classified as RA 5 years after diagnosis. The RA-keep group had a higher proportion of RF-positivity (63.1% vs 21.4% in RA-change group, p=0.001) and was more likely to fulfill >4 ACR1987 criteria (63.5% vs 34.1%, p=0.001). There was a higher proportion of patients with radiographic joint destruction at inclusion in RA-keep (26.5%) vs RA-change (12.2%, p=0.04). The erythrocyte sedimentation rate was incrased in the RA-keep compared to the RA-change group over 2 years from diagnosis (p=0.02). Conclusions: Diagnosis of RA should be reconsidered for patients who are RF-negative and do not fulfil more than 4 ACR1987 criteria.