Conflict Between Epidemiological And Clinical Diagnosis Of Rheumatoid Arthritis In A Population Sample

Abstract

Epidemiological surveys of rheumatoid arthritis (RA) yield a higher prevalence than do clinical materials. Several factors contribute to this situation. On the basis of material from an epidemiological survey of RA, an attempt has been made to quantify the area between epidemiological and clinical diagnosis of RA. Prevalence and cumulation patterns of “typical” medical signs and symptoms were studied, together with “typical” social items. Among 293 persons with epidemiological defined RA only 4 individuals fulfilled all 9 clinical criteria for being “typical” RA cases. When social items, such as low education and divorce, were included, only 1 out of 1246 epidemiological^ defined RA persons would have met this very strict definition of “typicalness”. It is concluded that the extreme rareness of the “typical RA-case” in epidemiological surveys should lead to a reconsideration of the clinical diagnostic use of the term “typicamess”.

Erik Allander, M.D. Department of Social Medicine Karolinska institutet Stockholm