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Evaluation of a modified ACR20 scoring system in patients with rheumatoid arthritis receiving treatment with etanercept


Objective: To evaluate a modified American College of Rheumatology 20 (mACR20) scoring system for patients with rheumatoid arthritis.

Methods: The data were evaluated from one study on patients with methotrexate (MTX)-naive early rheumatoid arthritis (ERA) and another study on patients with DMARD-refractory late rheumatoid arthritis (LRA). For mACR20 scoring, acute-phase reactant measurements were excluded, and 20% improvement from baseline was determined by 2 or 3 of the 4 remaining ACR components.

Results: For full joint counts with data from patients with ERA, marked differences favoured 25 mg etanercept (ETN) over 10 mg ETN by using the unmodified ACR20 (69% v 55%), the mACR203 of 4 (63% v 49%) and the mACR202 of 4 (72% v 58%). An assessment of 28 joints showed similar findings. In the trial on patients with LRA, considerably more patients in both ETN groups achieved a clinical response compared with placebo by using the ACR20, the mACR203 of 4 and the mACR202 of 4, whether using full or 28 joint counts. The mACR203 of 4 and full joint counts with data on patients with ERA showed a marked difference between the MTX and 10 mg ETN groups (63% v 49%), which was not observed with the ACR20.

Conclusion: Patterns of improvement indicated by mACR20 scores were consistent with standard ACR20 scores.

  • ACR, American College of Rheumatology
  • CRP, C reactive protein
  • DAS, Disease Activity Score
  • DMARD, disease-modifying antirheumatic drug
  • ERA, early rheumatoid arthritis
  • ESR, erythrocyte sedimentation rate
  • ETN, etanercept
  • LRA, late rheumatoid arthritis
  • mACR20, modified American College of Rheumatology 20
  • MTX, methotrexate

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