New RA criteria focus on early indicators to prevent later damage

New criteria for rheumatoid arthritis (RA) seek to redefine the disease by early indicators, allowing for earlier treatment to prevent joint damage in later disease stages.

The new criteria, developed jointly by the American College of Rheumatology (ACR) and the European League against Rheumatism, replace existing criteria published in 1987, which focused on established rather than early indicators of disease. They were jointly published in the September Arthritis & Rheumatism and the September Annals of the Rheumatic Diseases.

The work focused on identifying, among patients newly 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.

The new criteria classify “definite RA” as:

• confirmed presence of synovitis in at least one joint,absence of an alternative diagnosis to explain the synovitis, such as gout or infection, anda combined score of 6 or more out of 10 from each of the following four domains:
• number and sites of affected joints (range, 0 to 5),
• blood test results for autoantibodies indicative of RA (range, 0 to 3),
• evidence of an increase in inflammatory proteins (range, 0 to 1), and
• duration of symptoms (range, 0 to 1).

The 2010 criteria focus on early diagnosis and treatments that are effective in earlier stages of the disease, such as disease-modifying antirheumatic drugs.

The authors wrote, “The criteria are meant to be applied only to eligible patients, in whom the presence of obvious clinical synovitis in at least one joint is central. They should not be applied to patients with mere arthralgia or to normal individuals. However, once definite clinical synovitis has been determined (or historical documentation of such has been obtained)…a more liberal approach is allowed for determining the number and distribution of involved joints, which permits the inclusion of tender or swollen joints.”

For information on how general internal medicine physicians can partner with subspecialists to manage RA and its associated cardiovascular, cancer or infection risks, read the cover story in the current issue of ACP Internist.