ACR and EULAR New Diagnostic Criteria for RA
Purpose of review: This era of early aggressive treatment of rheumatoid arthritis (RA) calls for criteria that allow timely classification of patients at risk of persistent erosive disease. We review how the new American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria meet up to this challenge.
Recent findings: The new 2010 ACR/EULAR classification criteria for RA were developed using initiation of methotrexate as anchor in a population with undifferentiated arthritis. Many studies from different countries have now been published that have addressed the performances of these new criteria.
Summary: The goal of earlier classification of RA seems to be met with the new criteria, but exclusion of other diagnoses is essential. Increased sensitivity comes at the price of loss of specificity and indiscriminate use of these classification criteria as a diagnostic tool carries the risk of overtreatment.
Over the past two decades, the treatment of rheumatoid arthritis (RA) has rapidly improved. Where formerly care for the deteriorating RA patient was the main goal in rheumatology, cure has now become an option for many RA patients, through earlier and more aggressive treatment. RA is a clinical diagnosis as specific laboratory tests or histological findings are lacking. The only specific findings in RA are rheumatoid nodules and joint erosions, findings that may take time to develop. Up to 2010, the 1987 RA classification criteria of the American College of Rheumatology (ACR) were widely used. These criteria were developed in patients with established disease and had a sensitivity of 91% and a specificity of 89% for the expert based clinical diagnosis. Three out of its seven items concern relatively late findings in RA: rheumatoid erosions, rheumatoid nodules and rheumatoid factors. Therefore Aletaha et al. stated in 2005: development of contemporary criteria for the classification of RA is warranted.
Abstract and Introduction
Abstract
Purpose of review: This era of early aggressive treatment of rheumatoid arthritis (RA) calls for criteria that allow timely classification of patients at risk of persistent erosive disease. We review how the new American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria meet up to this challenge.
Recent findings: The new 2010 ACR/EULAR classification criteria for RA were developed using initiation of methotrexate as anchor in a population with undifferentiated arthritis. Many studies from different countries have now been published that have addressed the performances of these new criteria.
Summary: The goal of earlier classification of RA seems to be met with the new criteria, but exclusion of other diagnoses is essential. Increased sensitivity comes at the price of loss of specificity and indiscriminate use of these classification criteria as a diagnostic tool carries the risk of overtreatment.
Introduction
Over the past two decades, the treatment of rheumatoid arthritis (RA) has rapidly improved. Where formerly care for the deteriorating RA patient was the main goal in rheumatology, cure has now become an option for many RA patients, through earlier and more aggressive treatment. RA is a clinical diagnosis as specific laboratory tests or histological findings are lacking. The only specific findings in RA are rheumatoid nodules and joint erosions, findings that may take time to develop. Up to 2010, the 1987 RA classification criteria of the American College of Rheumatology (ACR) were widely used. These criteria were developed in patients with established disease and had a sensitivity of 91% and a specificity of 89% for the expert based clinical diagnosis. Three out of its seven items concern relatively late findings in RA: rheumatoid erosions, rheumatoid nodules and rheumatoid factors. Therefore Aletaha et al. stated in 2005: development of contemporary criteria for the classification of RA is warranted.