Rheumatological Societies Release New Classification Criteria

Physicians have new guidelines released by the American College of Rheumatology to help define rheumatoid arthritis at earlier stages.

The ACR released revised classification criteria for RA that allows the study of treatments for RA at earlier stages of disease, including before joint damage occurs. The criteria were created in collaboration with the European League Against Rheumatism.

The classification criteria, in general, allow researchers to define whether or not individuals have a certain disease, and help standardize recruitment into clinical trials and research studies; they are not intended as diagnostic criteria in clinical practice but may, in certain cases, be modified to serve that purpose.

The classification criteria for RA were updated in accordance to changes in knowledge. The previous time the criteria were updated was in 1987.

“The 1987 criteria actually posed a major barrier to the study of treatments designed to prevent joint damage in RA,” said Gillian Hawker, MD; senior author of the new criteria, in a press release. “Many patients did not fulfill the previous RA classification criteria until their disease was well-advanced, and - in many cases - joint damage had already occurred. This truly limited RA researchers from studying the disease at its earlier phases, which is critical to the development of new treatments to prevent damage.”

The endeavor to update the criteria began in 2008. The ACR worked with the EULAR and completed three phases of work to do so. First, they reviewed existing data collected from patients with early arthritis to determine the factors that best identified these patients. Next, the groups took the factors and came to a consensus on which were key in determining an individual’s likelihood of developing chronic joint damage. The last phase involved creating a scoring system based on the findings from the first two phases. The team came to the conclusion that patients to whom these criteria should be applied must have confirmed presence of joint swelling, indicating synovitis in at lease one joint, and no other possible diagnosis to explain the symptoms.

“To be classified as having 'definite RA,' patients must receive a score of six or greater (out of a possible 10),” explains Alan Silman, MD who initiated the project. “The scoring system takes into consideration the number and site/size of involved joints, laboratory tests of inflammation and auto-immunity, and symptom duration.”

“Under the correct circumstances, new knowledge resulting from rheumatology research can quickly move into applicable treatments for patients,” explains ACR President Stanley B. Cohen, MD. “We believe these new classification criteria will open the door to more meaningful studies of RA and will eventually lead to changes in the diagnosis and treatment of the disease. This is an important step for RA researchers, practicing rheumatologists and patients.”