Evaluation of Clinical Measures and Different Criteria for Diagnosis of Adult-onset Still's Disease in a Chinese Population

Objective. To determine the value of clinical measures in diagnosis of adult-onset Still's disease (AOSD), and to identify the optimal set of proposed classification criteria, in a Chinese population. Methods. A total of 70 patients with AOSD and 140 non-AOSD inpatients with fever were retrospectively identified at Zhongshan Hospital, Shanghai, from January 2003 to December 2009. Clinical measures and 4 sets of diagnostic criteria (Yamaguchi, Calabro, Cush, and Reginato) were evaluated by sensitivity, specificity, positive/negative predictive value (PPV, NPV), and positive/negative likelihood ratio (PLR, NLR) for diagnosis of AOSD. Results. In our series, higher sensitivity included hyperpyrexia (temperature >= 39 degrees C, 94.29%), arthralgia (80.0%), polymorphonuclear neutrophils (PMN) >= 75% (84.29%), serum ferritin >= 2-fold the upper normal value (90.0%), negative antinuclear antibodies (85.29%), and rheumatoid factor (84.38%); while higher specificity included transient erythema (98.57%), sore throat (85.0%), leukocytes >= 15,000/mm(3) (87.86%), and PMN >= 85% (85.0%). Rash, arthralgia, and sore throat were found to have better sensitivity and specificity (PLR 3.29-4.86). Leukocytes >= 10,000/mm(3), PMN >= 80%, and serum ferritin >= 5-fold the upper normal limit were set as critical points. The Reginato criteria set had the highest specificity, 99.29%. The Yamaguchi set had the highest sensitivity, 78.57%, with a better accuracy of 87.14%. Conclusion. The Yamaguchi diagnostic criteria had better accuracy in Chinese patients. Indicators such as rash, arthralgia, sore throat, leukocytes >= 10,000/mm(3), PMN >= 80%, and serum ferritin >= 5-fold the upper normal limit were helpful for diagnosis of AOSD. We recommend using these indicators in combination instead of alone. (First Release Feb 1 2011; J Rheumatol 2011;38:741-6; doi:10.3899/jrheum.100766)