[Evaluation of two proposals based on clinical factors for selecting what male patients with rheumatoid arthritis...

Criteria based on age, inflammation, and immobility have been proposed to identify which patients with rheumatoid arthritis (RA) should be examined by dual energy X-ray absorptiometry (DXA) to diagnose osteoporosis. Recently, a modified version of the criteria by including weight and the use of corticosteroids has been proposed. These two set of criteria have not been tested in male patients in a clinical setting.

To analyse, in a group of patients followed in a teaching hospital, the value of two proposals to select men with RA for bone densitometry.

Clinical and demographic data were collected from the charts of a total of 65 men with RA, submitted to the bone densitometry unit during a fouryear period. Bone mineral density (BMD) was measured in spine and femoral neck by DXA. Two set of criteria were tested: a) three item criteria (age, inflammation and immobility), and b) five item criteria (age, inflammation, immobility, weight, and ever use of corticosteroids). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Thirty five (54%) patients fulfilled the three item criteria and 38 (59%) the five item criteria. For the diagnosis of osteoporosis using the three item criteria, the sensitivity was 62%, specificity 48%, PPV 23% and NPV 83%; using the 5 item criteria the sensitivity was 90%, specificity 47%, PPV 23%, and NPV 96%.

The five item criteria are a more accurate tool to identify, in clinical practice, male patients with RA and osteoporosis than the three item criteria. It seems a good screening method for the selection of those patients with RA whose BMD should be assessed, as the sensitivity and NPV seem acceptable.