Refining serological scores in rheumatoid arthritis classification: an international study
Authors' conclusion
Serological weight factors for RA classification can be improved by taking into account the antibody type, the antibody levels and single or combined positivity. The application of an RSS reduced the number of RA misclassifications.
Study context
- Population
- Patients with rheumatoid arthritis (RA) and diseased controls (DC); investigative cohort of 398 RA and 448 DC; three confirmatory cohorts of 67, 157 and 132 RA and 441, 153 and 193 DC398 RA and 448 DC (investigative)
- Comparison
- Refined scoring system vs 2010 ACR/EULAR RA classification criteria
- Outcome
- Specificity of RA classification (misclassification)
Methodological detailsinternational, investigative cohort and three confirmatory cohorts, grid search across all possible integer score pairs for rheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA), RF and ACPA assays from five different manufacturers
- International
- Investigative cohort and three confirmatory cohorts
- Grid search across all possible integer score pairs for RF and ACPA
- RF and ACPA assays from five different manufacturers
Performance
As reported in the abstract
Misclassification in seropositive patients, investigative cohort
Refined scoring system (RSS)
15.0-26.9%
2010 criteria
38.3-55.8%
Further findings
| Outcome | RSS | 2010 criteria |
|---|---|---|
| Misclassification in seropositive patients, confirmatory cohorts | 8.6-36.8% | 20.0-78.9% |
| Sensitivity in seropositive patients, confirmatory cohorts | 86.7-97.3% | 86.7-96.0% |
Misclassification in seropositive patients, confirmatory cohorts
- Improved specificity of RSS validated in the confirmatory cohorts; RSS significantly decreased misclassification
Original publication
Refining serological scores in rheumatoid arthritis classification: an international study. RMD Open. Published 20 July 2026. doi:10.
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