Open Access2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative
Author(s) -
Aletaha Daniel,
Neogi Tuhina,
Silman Alan J.,
Funovits Julia,
Felson David T.,
Bingham Clifton O.,
Birnbaum Neal S.,
Burmester Gerd R.,
Bykerk Vivian P.,
Cohen Marc D.,
Combe Bernard,
Costenbader Karen H.,
Dougados Maxime,
Emery Paul,
Ferraccioli Gianfranco,
Hazes Johanna M. W.,
Hobbs Kathryn,
Huizinga Tom W. J.,
Kavanaugh Arthur,
Kay Jonathan,
Kvien Tore K.,
Laing Timothy,
Mease Philip,
Ménard Henri A.,
Moreland Larry W.,
Naden Raymond L.,
Pincus Theodore,
Smolen Josef S.,
StanislawskaBiernat Ewa,
Symmons Deborah,
Tak Paul P.,
Upchurch Katherine S.,
Vencovský Jiří,
Wolfe Frederick,
Hawker Gillian
Publication year - 2010
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.27584
Subject(s) - rheumatism , medicine , rheumatology , rheumatoid arthritis , synovitis , disease , physical therapy , arthritis , league , physics , astronomy
Abstract Objective The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized 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 3 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 “rheumatoid arthritis.” Results In the new criteria set, classification as “definite RA” is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0–5), serologic abnormality (score range 0–3), elevated acute‐phase response (score range 0–1), and symptom duration (2 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 minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct “rheumatoid arthritis.”