No 4, 2012

Publication of the Month

 

April 04/12: 

The 2010 ACR criteria improve the RA diagnosis

  

Key messages:

  • More RA patients are identified by the use of the 2010 ACR criteria, than the use of the 1987 ACR criteria.
  • The inclusion of anti-CCP enables the diagnosis of patients especially at disease onset.

 

Fautrel B, Combe B, Rincheval N, Dougados M
Level of agreement of the 1987 ACR and 2010 ACR/EULAR rheumatoid arthritis classification criteria: An analysis based on ESPOIR cohort data
Ann Rheum Dis 2012;71:386-389

  

Background: 
The onset of rheumatoid arthritis can take place long before disease manifestations are completed. As treatment with disease-modifying antirheumatic drugs (DMARD) has the best impact at early disease stage an early diagnosis of these patients is mandatory. The 2010 ACR classification criteria replaced those from 1987 in order to identify also patients with RA at disease onset.

 

Summary:

The aim of this study was to assess the difference between both criteria regarding the diagnosis of RA. The study included 811 patients of the ESPOIR cohort. The 2010 ACR criteria identified more RA patients (79%) than the 1987 ACR criteria (71.4%). After 2 years the percentage of patients fulfilling the criteria increases to an aligned portion of 87.2% for the 1987 set and 88.2% of the 2010 set. Patients fulfilling only the 1987 ACR criteria were more likely to have more swollen than tender joints, symmetrical joint involvement or morning stiffness, or to be negative for rheumatoid factor (RF) and anti-CCP. However, patients meeting only the 2010 ACR criteria were more likely to have a substantial number of tender joints (joint tenderness is considered equal to joint swelling), non-symmetrical joint involvement, or to be positive for RF or anti-CCP.

 

Conclusions:
With the use of the 2010 ACR criteria, more RA patients were identified than with the use of the 1987 ACR criteria. The 1987 ACR criteria were likely to miss patients with early RA. The 2010 ACR criteria may miss patients with symmetrical seronegative arthritis. The improvement is due to the inclusion of tender not just swollen joints, biological markers of inflammation and anti-CCP into the 2010 criteria. The weight of anti-CCP is now similar to that of RF.

  

Comment:
This publication shows that the introduction of the new 2010 ACR criteria was necessary and overdue to enable a better detection of RA patients, especially at disease onset when the impact and prospects of treatment is best. The inclusion and improved weight of anti-CCP into the 2010 ACR criteria supports the improved RA diagnosis.

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As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.