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EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria
  1. Désirée van der Heijde1,
  2. Annette H M van der Helm-van Mil1,
  3. Daniel Aletaha2,
  4. Clifton O Bingham3,
  5. Gerd R Burmester4,
  6. Maxime Dougados5,
  7. Paul Emery6,
  8. David Felson7,8,
  9. Rachel Knevel1,
  10. Tore K Kvien9,
  11. Robert B M Landewé10,
  12. Cédric Lukas11,
  13. Iain McInnes12,
  14. Alan J Silman13,
  15. Josef S Smolen2,
  16. Ewa Stanislawska-Biernat14,
  17. Angela Zink15,
  18. Bernard Combe11
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  3. 3Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4Department of Rheumatology and Clinical Immunology, Charité—University Medicine, Berlin, Germany
  5. 5Rheumatology B Department, Paris-Descartes University, Cochin Hospital, Paris, France
  6. 6Section of Musculoskeletal Disease, Leeds MSK Biomedical Unit LTHT, Leeds University, Leeds, UK
  7. 7Boston University School of Medicine, Boston, Massachusetts, USA
  8. 8University of Manchester, Manchester, UK
  9. 9Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  10. 10Department of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam and Atrium Medical Center, Heerlen, The Netherlands
  11. 11Department of Rheumatology, Lapeyronie Hospital, UMR 5534, Montpellier I University, Montpellier, France
  12. 12Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  13. 13Arthritis Research UK, Chesterfield, Manchester, UK
  14. 14Rheumatology Clinic, Institute of Rheumatology, Warsaw, Poland
  15. 15Department of Epidemiology, German Rheumatism Research Centre Berlin, Berlin, Germany
  1. Correspondence to Professor Désirée van der Heijde, Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands; mail{at}


The aim of this report was to propose a definition for erosive disease in the context of inflammatory arthritis in light of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) criteria for use in clinical practice and studies. A EULAR task force was formed including 16 rheumatologists and one rheumatology fellow. The process was both evidence based and consensus based, and included, between March 2010 and April 2012, analyses of data from two cohorts, two face-to-face meetings, one online voting and one teleconference. The Leiden Early Arthritis Cohort and the French ESPOIR cohort were used for the evidence-based part. The outcome measures, which were initiation of methotrexate therapy, or any disease-modifying antirheumatic drug therapy within the first year of disease and arthritis persistency over 5 years, were studied with the aim to give the best definition of erosive disease. A decision was made to select a definition with a high specificity and focus on patients who did not otherwise fulfil the 2010 ACR/EULAR RA criteria (<6 points). By a unanimous vote the following definition was selected: erosive disease for use in the 2010 ACR/EULAR RA classification criteria is defined when an erosion (defined as a cortical break) is seen in at least three separate joints at any of the following sites: the proximal interphalangeal, the metacarpophalangeal, the wrist (counted as one joint) and the metatarsophalangeal joints on radiographs of both hands and feet. A highly specific definition for erosive disease has thus been formulated.

  • Early Rheumatoid Arthritis
  • Epidemiology
  • Rheumatoid Arthritis

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