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Ann Rheum Dis 69:1580-1588 doi:10.1136/ard.2010.138461
  • Criteria

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

Editor's Choice
  1. Gillian Hawker31
  1. 1Medical University of Vienna, Vienna, Austria
  2. 2Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Arthritis Research UK, Chesterfield, UK
  4. 4Johns Hopkins University, Baltimore, Maryland, USA
  5. 5California Pacific Medical Center and University of California, San Francisco, California, USA
  6. 6Charité Hospital, University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
  7. 7Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
  8. 8National Jewish Medical and Research Center, Denver, Colorado, USA
  9. 9Lapeyronie Hospital and Montpellier I University, Montpellier, France
  10. 10Brigham and Women's Hospital and Harvard University, Boston, Massachusetts, USA
  11. 11Cochin Hospital, Assistance Publique-Hôpitaux de Paris and Paris-Descartes University, Paris, France
  12. 12University of Leeds and NIHR Leeds Muscoskeletal Biomedical Research Unit Leeds, UK
  13. 13School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
  14. 14Erasmus Medical Center, University Medical Center Rotterdam and University of Rotterdam, Rotterdam, The Netherlands
  15. 15University of Colorado School of Medicine, Denver, Colorado, USA
  16. 16Leiden University Medical Centre, Leiden, The Netherlands
  17. 17University of California, San Diego, California, USA
  18. 18UMass Memorial Medical Center and University of Massachusetts Medical School,Worcester, Massachusetts, USA
  19. 19Diakonhjemmet Hospital, Oslo, Norway
  20. 20University of Michigan, Ann Arbor, Michigan, USA
  21. 21Swedish Medical Center and University of Washington, Seattle, Washington, USA
  22. 22McGill University Health Centre and McGill University, Montreal, Quebec, Canada
  23. 23University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  24. 24Ministry of Health, Auckland, New Zealand
  25. 25New York University Hospital for Joint Diseases, New York, New York, USA
  26. 26Institute of Rheumatology, Warsaw, Poland
  27. 27University of Manchester, Manchester, UK
  28. 28Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  29. 29Institute of Rheumatology, Prague, Czech Republic
  30. 30National Data Bank for Rheumatic Diseases and University of Kansas, Wichita, Kansas, USA
  31. 31Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Alan J Silman, Arthritis Research UK, Copeman House, Chesterfield S41 7TD, UK; a.silman{at}arthritisresearchuk.org.
  1. Contributors All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. Dr Silman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design. Aletaha, Neogi, Silman, Felson, Birnbaum, Bykerk, Combe, Costenbader, Dougados, Emery, Hazes, Huizinga, Kay, Kvien, Moreland, Naden, Smolen, Stanislawska-Biernat, Vencovský, Hawker.

    Acquisition of data. Aletaha, Neogi, Silman, Bingham, Birnbaum, Burmester, Bykerk, Combe, Costenbader, Dougados, Emery, Hazes, Huizinga, Kavanaugh, Kay, Kvien, Laing, Ménard, Naden, Smolen, Stanislawska-Biernat, Tak, Upchurch, Vencovský, Hawker.

    Analysis and interpretation of data. Aletaha, Neogi, Silman, Funovits, Bingham, Birnbaum, Burmester, Bykerk, Cohen, Combe, Dougados, Emery, Ferraccioli, Hazes, Hobbs, Huizinga, Kay, Laing, Mease, Ménard, Moreland, Naden, Pincus, Smolen, Stanislawska-Biernat, Symmons, Tak, Upchurch, Vencovský, Wolfe, Hawker.

  • Accepted 28 June 2010

Abstract

Objective The 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticised for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA.

Methods A joint working group from the ACR and the European League Against Rheumatism developed, in three phases, a new approach to classifying RA. 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—this being the appropriate current paradigm underlying the disease construct ‘RA’.

Results In the new criteria set, classification as ‘definite RA’ is based on the confirmed presence of synovitis in at least one joint, absence of an alternative diagnosis better explaining the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in four domains: number and site of involved joints (range 0–5), serological abnormality (range 0–3), elevated acute-phase response (range 0–1) and symptom duration (two 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 minimise the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct ‘RA’.

Footnotes

  • This article is published simultaneously in the September 2010 issue of Arthritis & Rheumatism.

  • Supported by the American College of Rheumatology and the European League Against Rheumatism.

  • Funding Dr. Aletaha has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, UCB, Schering-Plough, Wyeth, and Roche (less than $10,000 each). Dr. Bingham has received consulting fees, speaking fees, and/or honoraria from UCB, Roche, Genentech, Celgene, and Merck Serono (less than $10,000 each); he has received research and/or educational grant support from Bristol-Myers Squibb, Genentech, UCB, Centocor, Abbott, and Amgen. Dr. Birnbaum has received consulting fees, speaking fees, and/or honoraria from Amgen, Pfizer, Centocor, Abbott, and UCB (less than $10,000 each). Dr. Burmester has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, Pfizer, UCB, and Roche (less than $10,000 each). Dr. Bykerk has received consulting fees, speaking fees, and/or honoraria from Amgen, Wyeth, Abbott, Schering-Plough, Roche, Bristol-Myers Squibb, and UCB (less than $10,000 each); her spouse is employed by Genzyme and owns stock in the company. Dr. Cohen has received consulting fees, speaking fees, and/or honoraria from UCB, Genentech, Bristol-Myers Squibb, and Human Genome Sciences (less than $10,000 each). Dr. Combe has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and Merck, Sharpe, and Dohme (less than $10,000 each). Dr. Emery has received consulting fees, speaking fees, and/or honoraria from Pfizer, Abbott, Centocor, UCB, Roche, Bristol-Myers Squibb, and Merck, Sharpe, and Dohme (less than $10,000 each). Dr. Ferraccioli holds a patent for T cell receptor clonotype analysis (PCT/IB 2008/053152 NP). Dr. Huizinga has received consulting fees, speaking fees, and/or honoraria from Schering-Plough, Bristol-Myers Squibb, UCB, Biotest AG, Wyeth/Pfizer, Novartis, Roche, Sanofi-Aventis, Abbott, and Axis-Shield (less than $10,000 each). Dr. Kavanaugh has conducted clinical research for Amgen, Abbott, Bristol-Myers Squibb, UCB, Roche, Centocor, Genentech, and Sanofi-Aventis. Dr. Kay has received consulting fees from Array BioPharma, Bristol-Myers Squibb, Celgene, Centocor, Genentech, Roche, UCB, and Sanofi-Aventis (less than $10,000 each). Dr. Mease has received consulting fees, speaking fees, and/or honoraria from Abbott, Amgen, Biogen Idec, Bristol-Myers Squibb, Centocor, Roche, Genentech, UCB, Pfizer, Novartis, and Eli Lilly (less than $10,000 each). Dr. Ménard has received unrestricted educational and research grants as well as consulting and speaking fees from Abbott, Amgen, Inova, Merck, Pfizer, Roche, Schering-Plough, UCB, and Wyeth (less than $10,000 each) and investigator-initiated research grants from Bristol-Myers Squibb, EuroImmun AG, and Roche (more than $10,000 each); he owns stock or stock options in Merck; and he has a license agreement with EuroImmun AG for an anti-Sa enzyme-linked immunosorbent assay. Dr. Moreland has received consulting fees, speaking fees, and/or honoraria from Biogen Idec, Centocor, Pfizer, Takeda, KaloBios, ChemoCentryx, UCB, Genentech, Incyte, and Eli Lilly (less than $10,000 each). Dr. Naden has received consulting fees from the American College of Rheumatology in regard to the methodology of developing weighted scoring systems (more than $10,000). Dr. Pincus has received consulting fees, speaking fees, and/or honoraria from Amgen, Abbott, Bristol-Myers Squibb, Centocor, UCB, Wyeth, and Genentech (less than $10,000 each) and investigator-initiated research grants from Amgen, Bristol-Myers Squibb, UCB, and Centocor. Dr. Stanislawska-Biernat has received speaking fees from Abbott and Pfizer (less than $10,000 each). Dr. Vencovský has received speaking fees from Pfizer, UCB, Abbott, Roche, and Merck, Sharpe, and Dohme (less than $10,000 each).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Accepted 28 June 2010

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