EDITORIAL - Classification criteria for RA - time to abandon rheumatoid factor (RF)?

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Rheumatology Advance Access originally published online on January 10, 2007

Rheumatology 2007 46(5):725-726; doi:10.1093/rheumatology/kel418

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EDITORIALS

Classification criteria for rheumatoid arthritis—time to abandon

rheumatoid factor?

D. P. M. Symmons

ARC Epidemiology Unit, Stopford Building, University of Manchester,

Oxford Road, Manchester M13 9PT, UK

The 1987 classification criteria for rheumatoid arthritis (RA) [1] are

nearly 20 yrs old. Ever since they were introduced, there have been

rumblings of discontent. Predominantly there has been a concern that

they do not perform well in the context of early inflammatory

arthritis [2, 3]. This lack of sensitivity in early disease was

acknowledged in the original paper. The criteria were developed by an

analytical approach using data from patients attending specialist

clinics for RA who had an average disease duration of over 7 yrs. The

comparison group of patients had other established diagnoses such as

osteoarthritis, fibromyalgia and lupus. They did not have early

undifferentiated arthritis. As with almost all criteria sets in

rheumatology, the 1987 ACR criteria use the 'physician's opinion' as

the gold standard. The problem with early RA is that the physician

cannot recognize it on clinical grounds alone. In fact, we have argued

that early RA does not exist and that patients either have established

RA or an undifferentiated inflammatory arthritis [4].

Unfortunately there has been a tendency to use the ACR criteria to

tell the physician which patients with early arthritis have RA and

which do not—i.e., for diagnosis, which was clearly never intended.

This has introduced special problems in the field of therapeutics. The

great majority of clinical trials in early arthritis has used the ACR

criteria as part of the inclusion criteria for the trial. Since trial

results can only be generalized to patients who would have satisfied

the entry criteria for the trial, this means that we have a very

limited evidence base for treating patients with early arthritis who

do not satisfy a set of criteria (the 1987 ACR criteria), which were

never developed to be used in this setting!

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Read the rest of the editorial here:

http://rheumatology.oxfordjournals.org/cgi/content/full/46/5/725

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Not an MD