2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative

Abstract

This criteria set has been approved by the American College of Rheumatology (ACR) Board of Directors and the European League Against Rheumatism (EULAR) ExecutiveCommittee. This signifies that the criteria set has been quantitatively validated using patient data, and it has undergone validation based on an external data set. All 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."

High Adherence to System‐Level Performance Measures for Rheumatoid Arthritis in a National Early Arthritis Cohort Over Eight Years

“…For example, patients may not have fulfilled RA criteria or had undifferentiated or palindromic presentations and were treated with a DMARD before a formal diagnosis of RA was made. Also the paradigm for the diagnosis of patients recruited before the 2010 ACR/EULAR criteria 11 were published may have meant that patients were being treated off‐label before a formal RA diagnosis was made according to the older ACR criteria 10. When calculating the median and 90th percentile, as recommended when reporting on this measure 7, this calculation incurred negative values for the patients treated before diagnosis.…”

“…Patients from CATCH were included in the study if they met either 1987 ACR 10 or 2010 ACR/European League Against Rheumatism (EULAR) criteria for RA with <1 year of symptom duration at enrollment 11. Patients who had not yet reached their expected 1‐year followup date or those missing the date of first treatment start were also excluded, as they would not have enough followup time to be eligible for performance measurement.…”

Baricitinib, Methotrexate, or Combination in Patients With Rheumatoid Arthritis and No or Limited Prior Disease‐Modifying Antirheumatic Drug Treatment

“…We included patients age ≥18 years with adult‐onset RA, classified by the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 criteria 3, who had received no prior csDMARD therapy (up to 3 weekly MTX doses permitted) and no prior bDMARD therapy. Patients had active disease (≥6 of 68 tender joints and ≥6 of 66 swollen joints; serum high‐sensitivity C‐reactive protein [hsCRP] level ≥3.6 mg/liter [upper limit of normal 3.0 mg/liter]) and were seropositive for rheumatoid factor (RF) or anti–citrullinated protein antibodies (ACPAs) 3.…”

“…Patients had active disease (≥6 of 68 tender joints and ≥6 of 66 swollen joints; serum high‐sensitivity C‐reactive protein [hsCRP] level ≥3.6 mg/liter [upper limit of normal 3.0 mg/liter]) and were seropositive for rheumatoid factor (RF) or anti–citrullinated protein antibodies (ACPAs) 3. Exclusion criteria included recent clinically significant infection and select laboratory abnormalities (aspartate aminotransferase or alanine aminotransferase [ALT] >1.5 times upper limit of normal, hemoglobin <10.0 gm/dl, neutropenia <1,200 cells/µl, lymphopenia <750 cells/µl, and estimated glomerular filtration rate [GFR] <40 ml/minute/1.73 m 2 ).…”

“…In patients with early RA, methotrexate (MTX) alone or in combination with other conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) remains the “anchor” therapy, and early intervention improves clinical outcomes and reduces joint damage and future disability 3. However, approximately one‐third of patients are intolerant of MTX treatment, with discontinuation of MTX being common in clinical practice 4, 5.…”