Predictive value of autoantibody testing for validating self-reported diagnoses of rheumatoid arthritis in the Women's Health Initiative.

MedStar author(s):
Citation: American Journal of Epidemiology. 177(9):887-93, 2013 May 1.PMID: 23492764Institution: MedStar Washington Hospital CenterDepartment: Medicine/RheumatologyForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., ExtramuralSubject headings: *Arthritis, Rheumatoid/di [Diagnosis] | *Autoantibodies/du [Diagnostic Use] | *Rheumatoid Factor/bl [Blood] | Antibodies, Anti-Idiotypic/bl [Blood] | Antibodies, Anti-Idiotypic/du [Diagnostic Use] | Antibodies, Anti-Idiotypic/im [Immunology] | Arthritis, Rheumatoid/bl [Blood] | Arthritis, Rheumatoid/im [Immunology] | Autoantibodies/bl [Blood] | Biological Markers/bl [Blood] | Cohort Studies | Female | Humans | Middle Aged | Peptides, Cyclic/bl [Blood] | Peptides, Cyclic/du [Diagnostic Use] | Peptides, Cyclic/im [Immunology] | Predictive Value of Tests | Reproducibility of Results | Rheumatoid Factor/du [Diagnostic Use] | Rheumatoid Factor/im [Immunology] | Self Report | Women's HealthYear: 2013Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 0002-9262
Name of journal: American journal of epidemiologyAbstract: Rheumatoid arthritis (RA) research using large databases is limited by insufficient case validity. Of 161,808 postmenopausal women in the Women's Health Initiative, 15,691 (10.2%) reported having RA, far higher than the expected 1% population prevalence. Since chart review for confirmation of an RA diagnosis is impractical in large cohort studies, the current study (2009-2011) tested the ability of baseline serum measurements of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, second-generation assay (anti-CCP2), to identify physician-validated RA among the chart-review study participants with self-reported RA (n = 286). Anti-CCP2 positivity had the highest positive predictive value (PPV) (80.0%), and rheumatoid factor positivity the lowest (44.6%). Together, use of disease-modifying antirheumatic drugs and anti-CCP2 positivity increased PPV to 100% but excluded all seronegative cases (approximately 15% of all RA cases). Case definitions inclusive of seronegative cases had PPVs between 59.6% and 63.6%. False-negative results were minimized in these test definitions, as evidenced by negative predictive values of approximately 90%. Serological measurements, particularly measurement of anti-CCP2, improved the test characteristics of RA case definitions in the Women's Health Initiative.All authors: Chang YF, Deane KD, Holers VM, Kuller L, Mackey R, Moreland L, Robinson W, Walitt BFiscal year: FY2013Digital Object Identifier: Date added to catalog: 2014-08-21
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 23492764 Available 23492764

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

Rheumatoid arthritis (RA) research using large databases is limited by insufficient case validity. Of 161,808 postmenopausal women in the Women's Health Initiative, 15,691 (10.2%) reported having RA, far higher than the expected 1% population prevalence. Since chart review for confirmation of an RA diagnosis is impractical in large cohort studies, the current study (2009-2011) tested the ability of baseline serum measurements of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, second-generation assay (anti-CCP2), to identify physician-validated RA among the chart-review study participants with self-reported RA (n = 286). Anti-CCP2 positivity had the highest positive predictive value (PPV) (80.0%), and rheumatoid factor positivity the lowest (44.6%). Together, use of disease-modifying antirheumatic drugs and anti-CCP2 positivity increased PPV to 100% but excluded all seronegative cases (approximately 15% of all RA cases). Case definitions inclusive of seronegative cases had PPVs between 59.6% and 63.6%. False-negative results were minimized in these test definitions, as evidenced by negative predictive values of approximately 90%. Serological measurements, particularly measurement of anti-CCP2, improved the test characteristics of RA case definitions in the Women's Health Initiative.

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