The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip

Authors: Altman R (1) , Alarcón G (2) , Applerouth D , Bloch D (3) , Borenstein D (4) , Brandt K (5) , Brown C (6) , Cooke TD (7) , Chir B (7) , Daniel W (2) , Feldman D (8) , Greenwald R (9) , Hochberg M (10) , Howell D (1) , Ike R (11) , Kapila P (1) , Kaplan D (8) , Marino C (12) , McDonald E (12) , McShane DJ (3) , Michel B (13) , Murphy W (14) , Osial T , Ramsey-Goldman R (13) , Rothschild B (15) , Wolfe F (16,17)
(1) University of Miami School of Medicine (2) University of Alabama at Birmingham (3) Stanford University (4) George Washington University Medical Center (5) Indiana University School of Medicine (6) Rush-Presbyterian-St. Luke's Medical Center, Chicago (7) Queen's University, Kingston, Ontario (8) Downstate Medical Center, Brooklyn, NY (9) Long Island Jewish Medical Center, New Hyde Park, NY (10) Johns Hopkins University, Baltimore (11) University of Michigan, Ann Arbor (12) St. Johns Queens Hospital Center, Elmhurst (13) University of Pittsburgh (14) Mallinckrodt Institute of Radiology, Washington University (15) Arthritis Center of Northeast Ohio (16) University of Kansas (17) American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research)
Source: Arthritis Rheum. 1991 May;34(5):505-14.
DOI: 10.1002/art.1780340502 Publication date: 1991 May E-Publication date: Dec. 9, 2005 Availability: abstract Copyright: Copyright © 1991 American College of Rheumatology
Language: English Countries: Not specified Location: Not specified Correspondence address: Altman R. :
American College of Rheumatology, 60 Executive Park South, Suite 150, Atlanta, GA 30329


Article abstract

Clinical criteria for the classification of patients with hip pain associated with osteoarthritis (OA) were developed through a multicenter study. Data from 201 patients who had experienced hip pain for most days of the prior month were analyzed. The comparison group of patients had other causes of hip pain, such as rheumatoid arthritis or spondylarthropathy. Variables from the medical history, physical examination, laboratory tests, and radiographs were used to develop different sets of criteria to serve different investigative purposes. Multivariate methods included the traditional "number of criteria present" format and "classification tree" techniques. Clinical criteria: A classification tree was developed, without radiographs, for clinical and laboratory criteria or for clinical criteria alone. A patient was classified as having hip OA if pain was present in combination with either 1) hip internal rotation greater than or equal to 15 degrees, pain present on internal rotation of the hip, morning stiffness of the hip for less than or equal to 60 minutes, and age greater than 50 years, or 2) hip internal rotation less than 15 degrees and an erythrocyte sedimentation rate (ESR) less than or equal to 45 mm/hour; if no ESR was obtained, hip flexion less than or equal to 115 degrees was substituted (sensitivity 86%; specificity 75%). Clinical plus radiographic criteria: The traditional format combined pain with at least 2 of the following 3 criteria: osteophytes (femoral or acetabular), joint space narrowing (superior, axial, and/or medial), and ESR less than 20 mm/hour (sensitivity 89%; specificity 91%). The radiographic presence of osteophytes best separated OA patients and controls by the classification tree method (sensitivity 89%; specificity 91%). The "number of criteria present" format yielded criteria and levels of sensitivity and specificity similar to those of the classification tree for the combined clinical and radiographic criteria set. For the clinical criteria set, the classification tree provided much greater specificity. The value of the radiographic presence of an osteophyte in separating patients with OA of the hip from those with hip pain of other causes is emphasized.

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