New Classification Criteria for Rheumatoid Arthritis

Aletaha D et al. 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology / European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010 Sep; 62:2569. (http://dx.doi.org/10.1002/art.27584)


The American College of Rheumatology (ACR) and the European League Against Rheumatism have collaboratively developed new classification criteria for rheumatoid arthritis (RA); the ACR's previous criteria were published in 1987.

First, a working group analyzed data from several large cohorts of patients with early synovitis to determine predictors of eventual requisite disease-modifying therapy with disease-modifying drugs.

Second, 24 RA experts used a consensus-based decision-analytic approach to reach agreement on key predictors of RA. Both sources of information were used to construct the new classification system, which can be applied to patients who have at least one joint with clinical synovitis that is not explained better by another disease.

Four variables constitute the new criteria:

•The number and size of involved joints (score, 0–5)

•Results of rheumatoid factor and anti–citrullinated protein antibody testing (score, 0–3)

•Abnormal sedimentation rate or elevated C-reactive protein level (1 point)

•Symptom duration >6 weeks (1 point)


Maximal score is 10 points; patients whose scores are 6 points are considered to have "definite RA"

Comment:

The goal of this classification scheme is early identification of patients with undifferentiated synovitis who are likely to progress to erosive RA and thus might benefit from early initiation of disease-modifying therapy.