New rheumatoid arthritis criteria aimed at stopping disease in early onset

A redefinition of how rheumatoid arthritis should be classified could prevent patients from developing disabling late stage disease, according to researchers.

The new criteria, published in the Annals of Rheumatic Diseases, were developed jointly in three phases by the American College of Rheumatology and the European League Against Rheumatism and are based on data from patients and clinical consensus.

“The new criteria redefine [rheumatoid arthritis], reflecting our collective hope that in the future, [rheumatoid arthritis] will no longer be characterized by erosive joint disease and persistence of symptoms,” the authors wrote, “although these characteristics will continue to define established or longstanding untreated disease.”

Picking up on disease early

The new criteria replace those published by the American College of Rheumatology in 1987, which focused on established — rather than early — indicators of the disease. The focus is now on early diagnosis and treatment, which is reported to have become increasingly important with the advent of more effective drug treatments throughout the past decade.

If the disease is picked up early, synthetic and biological disease-modifying antirheumatic drugs can prevent the destructive and disabling joint damage which is characteristic of late-stage rheumatoid arthritis. The new criteria aim to recognize the disease early on in development, giving physicians the opportunity to target preventative treatment more effectively, the authors wrote.

The criteria will also allow researchers to channel patients who could benefit from promising new therapies into clinical trials.

Definite characterizations

According to the new criteria, “definite rheumatoid arthritis” is characterized by:

The confirmed presence of synovitis – inflammation of the synovial membrane that lines the joint – in at least one joint;
The absence of an alternative diagnosis to explain the presence of synovitis, and
A combined score of 6 or more from each of the following 4 domains: number and sites of affected joints, blood test results, the evidence of an increase in inflammatory proteins, and how long symptoms have lasted.

Reference:
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;1580 69:1580–1588. doi:10.1136/ard.2010.138461.

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