New classification criteria redefine RA paradigm

New classification criteria for rheumatoid arthritis (RA) have been developed by the American College of Rheumatology and the European League Against Rheumatism. The scheme is designed to offer a standardized approach to identifying patients who present with an otherwise unexplained inflammatory arthritis of a peripheral joint and will benefit from treatment with disease-modifying antirheumatic drugs (DMARDs).

Aletaha and colleagues developed criteria that could be applied to patients with new-onset undifferentiated synovitis. The criteria had to accomplish the following: identify patients at high risk for chronic, erosive joint damage; support the rationale for early DMARD therapy; and identify patients who present with late-stage as well as early RA.

Three findings satisfied these requirements and pinpointed patients with definite RA. The findings are confirmed synovitis in at least 1 joint; absence of another explanation for symptoms; and a total score of at least 6 out of 10 in 4 domains (number and site of involved joints, serological abnormality, elevated acute-phase response, and symptom duration).

The investigators noted that this new paradigm is for “rheumatoid arthritis,” not “early” RA; that the new criteria do not provide an RA referral tool for primary care physicians; and that an easy-to-use referral tool is needed.