Journal
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
Volume 59, Issue 9, Pages 1314-1321Publisher
WILEY-LISS
DOI: 10.1002/art.24015
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Funding
- Arthritis Research Campaign [16012]
- Wellcome Trust Senior Research Fellowship in Clinical Science
- MRC [G0400491] Funding Source: UKRI
- Medical Research Council [U1475000001, G0400491] Funding Source: researchfish
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Objective. To identify characteristics that predict a valid rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA) diagnosis among RA- and JIA-coded individuals in the General Practice Research Database (GPRD), and to assess limitations of this type of diagnostic validation. Methods. Four RA and 2 JIA diagnostic groups were created with differing strengths of evidence of RA/JIA (Group 1 = strongest evidence), based oil RA/JIA medical codes. Individuals were sampled from each group and clinical and 0 prescription data were extracted from anonymized hospital/practice correspondence and electronic records. American College of Rheumatology and International League of Associations for Rheumatology diagnostic criteria were, used to validate diagnoses. A data- derived diagnostic algorithm that maximized sensitivity and specificity was identified using logistic regression. Results. Among 223 RA-coded individuals. the diagnostic algorithm classified individuals as having RA if they had an appropriate GPRD disease-modifying antirheumatic drug prescription or 3 other GPRD characteristics: >1 RA code during followup, RA diagnostic Group 1 or 2, and no later alternative diagnostic code. This algorithm had >80% sensitivity and specificity when applied to a test data set. Among 101 JIA-coded individuals, the strongest predictor of a valid diagnosis was a Group 1 diagnostic code (>90% sensitivity and specificity). Conclusion. Validity of an RA diagnosis among RA-coded GPRD individuals appears high for patients with specific characteristics. The findings are important for both interpreting results Of Published GPRD studies and identifying RA/JIA patients for future GPRD-based research. However, several limitations were identified, and further debate is needed on how best to validate chronic disease diagnoses in the GPRD.
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