評估1980年美國風濕病學會與2013年美國／歐洲風濕病學會全身性硬化症分類標準的適用性－－南臺灣某醫學中心的病歷回溯調查

Evaluation of the applicability of the 2013 ACR/EULAR and the 1980 ACR classification criteria for systemic sclerosis, an experience from a medical center in southern Taiwan

目的：利用南台灣某醫學中心全身性硬化症病患來評估1980年美國風濕病學會與2013年美國／歐洲風濕病學會全身性硬化症之分類標準的敏感度，並比較病患的臨床表現。方法：對國立成功大學醫學院附設醫院於民國九十二年至一百零二年間被診斷全身性硬化症之成人進行病歷回溯性調查。我們記錄這些病患的臨床表現，實驗室與影像檢查，應用1980年美國風濕病學會與2013年美國／歐洲風濕病學會全身性硬化症之分類標準將病患分成兩組，分析比較兩組臨床表現的差異。結果：共有52位全身性硬化症患者納入分析，其中27位符合1980年美國風濕病醫學會之分類標準（1980組），42位符合2013年美國風濕病醫學會分類標準（2013組），敏感度分別為51.9%和80.8%（p=0.003）。 在25位不符合1980年分類標準的全身性硬化症患者中，有16位（16/25，64%）符合2013年分類標準。只有一個病人僅符合1980年分類標準，但不符合2013年分類標準。這兩組病患之間在臨床表現上並無統計學上差異。結論：於南台灣全身性硬化症病患的分析中，確認新的分類標準可顯著提高診斷的敏感度，但新舊標準所定義出的病患在疾病的臨床表現上並無統計學上差異。

Objective: To evaluate the sensitivity of the ACR 1980 and ACR/EULAR 2013 classification criteria for systemic sclerosis (SSc), and the difference in clinical presentations between patients of the two classified groups, based on a cohort from a single hospital. Methods: We retrospectively reviewed the medical records of all patients with SSc between January 2003 and November 2013. Patients who were clinically diagnosed with SSc by rheumatologists in a single hospital and had available medical records were enrolled for analysis. Both the ACR 1980 and ACR/EULAR 2013 classification criteria were applied to these patients to categorize them into two groups. The between-group differences of clinical manifestations were analyzed. Results: A total of 52 SSc patients were enrolled, of whom, 27 fulfilled the 1980 ACR classification criteria (1980-group) and 42 fulfilled the 2013 ACR/EULAR classification criteria (2013-group). The sensitivities are 51.9% and 80.8% respectively (p=0.003). Of the 25 SSc patients who did not fulfill 1980 criteria, 16 (16/25, 64%) did fulfill 2013 criteria. Only one patient fulfilled the 1980 criteria but not the 2013 criteria. There are no statistical differences between the two classified groups in terms of internal organ involvement or positivity of autoantibodies. Conclusion: The new 2013 ACR/EULAR classification criteria for systemic sclerosis has better sensitivity in the patients of a medical center in southern Taiwan, and there are no differences between the two classified groups in terms of internal organ involvement or positivity of autoantibodies.