Rheum 2010; 62: 2569-2581
Over the last decade, the optimal use of disease modifying antirheumatic drugs (DMARDs) and the availability of new biologic agents have dramatically enhanced the success of RA management. Moreover, it has been recognized that early therapeutic intervention improves clinical outcomes and reduces the accrual of joint damage and disability. Undoubtedly, treating patients at a stage at which evolution of joint destruction can still be prevented would be ideal.
The classification criteria set that is in widespread international use to define RA is the 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) criteria. These criteria are well accepted as providing the benchmark for disease definition, but are not helpful in identifying patients who would benefit from early effective intervention. Indeed, with modern therapies, the goal is to prevent individuals from reaching the chronic, erosive disease state that is exemplified in the 1987 criteria for RA.
A joint working group of the ACR and the European League Against Rheumatism (EULAR) was therefore formed to develop a new approach for classification of RA. While classification criteria are potentially adopted for use as aids for diagnosis, the focus of this endeavor was not on developing diagnostic criteria or providing a referral tool for primary care physicians. Thus, the specific charge was to develop new classification criteria for RA to facilitate the study of persons at earlier stages of the disease.
The criteria are scored with points, with 10 points being the maximum. Four categories are judged: the number of affected joints, the serology (rheumatoid factor and ACPA), inflammatory markers, and the duration of symptoms. Please find the new criteria and their scoring on the next page.