New Rheumatoid Arthritis Classifications Focus on Identifying DiseaseEarlier

The American College of Rheumatology announced the release of revised
classification criteria, created in collaboration with the European League
Against Rheumatism, (EULAR) for rheumatoid arthritis (RA), which will allow the
study of treatments for RA at much earlier stages of the disease — before
joint damage occurs — ultimately leading to better patient outcomes.

Classification criteria are typically updated as knowledge changes,
which is the case with the new RA criteria – published in, Arthritis
& Rheumatism
. The previous criteria were created in 1987. Since that
time, new therapies have emerged that can prevent joint damage in people with
RA. With these modern therapies, the goal of treatment is to prevent people
from reaching the point where their RA is causing chronic damage to their

“The 1987 criteria actually posed a major barrier to the study of
treatments designed to prevent joint damage in RA,” Gillian Hawker, MD,
senior author of the new criteria, stated in a press release. “Many
patients did not fulfill the previous RA classification criteria until their
disease was well-advanced, and — in many cases — joint damage had
already occurred. This truly limited RA researchers from studying the disease
at its earlier phases, which is critical to the development of new treatments
to prevent damage.”

In 2008, the ACR began a collaborative project with the EULAR to create
the first new set of RA classification criteria in 20 years. To establish the
new criteria, researchers completed three phases of work. The first phase (led
by EULAR) involved reviewing existing data collected from patients with early
arthritis to determine which factors best identified patients who had the
highest risk.

The second phase of work was aimed at reaching consensus among
practicing rheumatologists on which factors were most important in determining
a person’s likelihood of developing the chronic joint damage that has been
known for many years as the hallmark of RA.

In phase three, researchers integrated the findings from the first two
phases of work, refined a scoring system, and determined the optimal cut off
point to define the disease.

“To be classified as having ‘definite RA,’ patients must receive a
score of six or greater (out of a possible 10),” Alan Silman, MD, who
initiated the project, stated in a press release. “The scoring system
takes into consideration the number and site/size of involved joints,
laboratory tests of inflammation and auto-immunity, and symptom duration.”

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