RESEARCH - 2010 RA classification criteria: an ACR/EULAR collaborative initiative

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Ann Rheum Dis. 2010 Sep;69(9):1580-8.

2010 rheumatoid arthritis classification criteria: an American College

of Rheumatology/European League Against Rheumatism collaborative

initiative

Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd,

Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader

KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga

TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA,

Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E,

Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G.

Abstract

OBJECTIVE: The 1987 American College of Rheumatology (ACR; formerly

the American Rheumatism Association) classification criteria for

rheumatoid arthritis (RA) have been criticised for their lack of

sensitivity in early disease. This work was undertaken to develop new

classification criteria for RA.

METHODS: A joint working group from the ACR and the European League

Against Rheumatism developed, in three phases, a new approach to

classifying RA. The work focused on identifying, among patients newly

presenting with undifferentiated inflammatory synovitis, factors that

best discriminated between those who were and those who were not at

high risk for persistent and/or erosive disease--this being the

appropriate current paradigm underlying the disease construct 'RA'.

RESULTS: In the new criteria set, classification as 'definite RA' is

based on the confirmed presence of synovitis in at least one joint,

absence of an alternative diagnosis better explaining the synovitis,

and achievement of a total score of 6 or greater (of a possible 10)

from the individual scores in four domains: number and site of

involved joints (range 0-5), serological abnormality (range 0-3),

elevated acute-phase response (range 0-1) and symptom duration (two

levels; range 0-1).

CONCLUSION: This new classification system redefines the current

paradigm of RA by focusing on features at earlier stages of disease

that are associated with persistent and/or erosive disease, rather

than defining the disease by its late-stage features. This will

refocus attention on the important need for earlier diagnosis and

institution of effective disease-suppressing therapy to prevent or

minimise the occurrence of the undesirable sequelae that currently

comprise the paradigm underlying the disease construct 'RA'.

PMID: 20699241

http://www.ncbi.nlm.nih.gov/pubmed/20699241

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