Comparative Study Of1987ACR And2010EULAR/ACR Classification Criteria For Rheumatoid Arthritis

BackgroundRheumatoid arthritis (RA) is often challenging, due to a wide spectrum of presentations, progressive changes in disease course over time, and perhaps, most importantly, lack of a clinical or laboratory gold standard to define the presence or absence of disease. Clinical diagnosis often relies on the overall opinion of the evaluating clinician. Classification criteria for RA were first proposed, in1956,and ultimately adopted and published by the American Rheumatism Association(ARA) in1958. As the1958criteria included a number of histological features, thus making the criteria more applicable for use in epidemiological studies. While the1958criteria separated patients into possible, probable, definite, and classic RA, the revision, known as the New York Criteria, were poorly received due to lack of a defined cut-point for definite cases of RA. A major challenge to the development of RA classification criteria has stemmed from the need to include information from varied stemmed from the need to include information from varied domains, including patient history and health status, physical examination and physician assessment, appropriately supplemented by laboratory and imaging studies. It soon became clear there were significant limitations to use of these criteria with respect to both sensitivity and specificity. Such as the presence of severe bilateral synovitis in a seronegative patient who has not yet developed radiographic changes. Acute phase reactants, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are markers of inflammation that are not specific for RA. Though elevations in one or both can be helpful, their uniquitous nature in many inflammatory states, as well as their absence in as many as40%of patients with active RA, prevents them from becoming a gold standard for the diagnosis of RA. Anti-cyclic citrullinated peptides (anti-CCP), have been identified as important for both the diagnosis and subsequent prognosis in RA. Although the presence of anti-CCP Abs offers better specificity than RF (95%-97%/65%-75%), the two tests have similar sensitivity for diagnosis. However, there is evidence, especially in subjects with very early or undifferentiated, that use of both RF and anti-CCP testing can improve diagnostic specificity with a minimal loss of sensitivity. Nonetheless, up to30%of RA patients do not have usual biomarkers of RF, anti-CCP, elevated ESR, or CRP.In the early1990s, several groups suggested re-evaluation of the1987criteria, noting poor performance of pain and morning stiffness domains.Diagnostic specificity still derived mainly from radiographic and serologic data. To advantage of newer biomarkers, addition of anti-CCP Abs as a criteria or their inclusion to replace the much less common, but also highly specific nodules-erosions criteria.With the above limitations, a combined task force of experts from the ACR and European League Against Rheumatism (EULAR) collaborated to develop the combined ACR/EULAR classification criteria for the diagnosis of RA. The new scoring system of the2010ACR/EULAR criteria includes four domains:joints involves, types of joints involved, and laboratory biomarkers of inflammation and autoimmunity. They are specifically intended for use in early disease. The advent of anti-CCP Abs has allowed to increase diagnostic specificity, especially in early RA. Weighting for an increased number of involved joints was also added, characteristic consistently shown to identify those at higher risk for the development of chronic, persistent inflammatory arthritis.At present, there is not research report of2010standard features and significance.This research aims to study the features of patients and early diagnosis of the significance, to further study the new standard feasibility in early RA patients in our country.Objective:New criteria to classify rheumatoid arthritis (RA) have been derived in order to increase the specificity and sensitivity for early RA compared with the1987American college of Rheumatology (ACR) criteria. The aim of this study was to evaluate differences in classification between the1987ACR criteria and the2010ACR/European League Against Rheumatism (EULAR) criteria in an early arthritis patients and to determine the test characteristics of the2010ACR/EULAR criteria.Methods A total of410patients with recent-onset arthritis of<6mouths duration were studied prospectively between2009and2010and followed-up for1year. Fulfillment of the1987and2010criteria for the classification of RA was determined at baseline.The diagnosis of each patient at1year was assessed. The sensitivity and specificity of the2010criteria were determined using the following outcome measures:initiation of methotrexate therapy or any disease-modifying anti-rheumatic drug (DMARD) therapy during the first year of follow-up. The diagnostic performance of the criteria was evaluated using methotrexate treatment within1year.Results During the first year,16patients had excluded from the study because they could not follow-up in time.174patients fulfilled the2010criteria, and94patients fulfilled the1987criteria for RA. The2010criteria when applied at baseline detected more patients who eventually required disease-modifying anti-rheumatic drug (DMARD)(129(62%)/79(38%),P<0.05),especially methotrexate (100(68%)/62(42%), P<0.05),within the first12months. However, more patients whose disease eventually resolved without ever requiring DMARD were classified at baseline as RA according to the2010criteria than with the1987criteria(31(8%)/9(2%),P<0.05). At baseline, the2010and1987criteria fulfilled rate were69.9%,43%, respectively; loss rate were5.4%,32.3%respectively,; misdiagnosis rate were24.2%,8.1%respectively. After fowllowup, the2010and1987criteria fulfilled rate were63.7%,76.5%, respectively; loss rate is.7%,1%respectively; misdiagnosis rate were12.3%,12.3%respectively.At baseline, the sensitivity and specificity of the2010criteria with the methotrexate therepy as the outcome were0.69and0.73, with DMARD therapy as the outcome were0.63and0.77.After lyear followup, the sensitivity and specificity of the2010criteria with the methotrexate therepy as the outcome were0.70and0.71, with DMARD therapy as the outcome were0.74and0.74.Conclusion. Compared with the1987criteria, the2010criteria classify more patients with RA at an earlier phase of the disease. Although the discriminative ability is slightly higher on the group levels and RA may be faisely diagnosed in some patients with self-limiting disease. The ability of the new criteria to identity patients with erosive disease was lower possible owing to the effect of intensive treatment.