NEW CLASSIFICATION TREE AND CRITERIA SET, INCLUDING FERRITIN AND GLYCOSYLATED FERRITIN, FOR ADULT STILL'S DISEASE

 E Zing, B Fautrel, G Le Moel, A Bisseri, J L Golmard, C Rioux, J C Piette, P Bourgeois. Paris, Fance.

Despite Yamaguchi's criteria, the diagnosis of adult Still's disease (ASD) is difficult, because occult infections, neoplasias or other inflammatory diseases must be excluded prior to retain ASD. Recently, we and other authors have shown that a high serum ferritin value (>5N) combined with a decreased glycosylated ferritin (<20%) is an interesting tool to assess ASD diagnosis.

To evaluate the place of ferritin and glycosylated ferritin among other diagnostic parameters, including Yamaguchi's criteria, we retrospectively reviewed 192 adults, 71 ASD patients and 121 controls with either infectious, neoplastic or inflammatory diseases. For all patients, we used a standardized procedure to collect clinical and biological data, including ferritin and glycosylated ferritin. Items were considered as pertinent for ASD diagnosis if: (a) their relative value (sum of sensitivity and specificity) was higher than 140, (b) their sensitivity was higher than 90%.
Selected diagnostic criteria found were : leukocytosis >10,000/mm3, polymorphonuclear >80%, typical rash, arthralgias, fever >39°C, sore throat, serum ferritin >5N and glycosylated ferritin <20%, negative rheumatoid factor, negative nuclear antibodies. A logistic regression was performed and a classification tree was built to determine a hierarchy within the criteria, including ferritin and glycosylated ferritin among other previously described criteria.

This retrospective work constitute a preliminary study, and need a further validation in a prospective multicentric study. With this new set of criteria, we hope to lower the weight of Yamaguchi's exclusion criteria in the diagnosis of ASD.

ACR Poster Session E: Miscellaneous Rheumatic Diseases (8:00 AM-9:30 AM)

Presentation Date: Tuesday, November 16, 1999, Time: 8:00AM, Room: Hall B