Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


New 2010 ACR-EULAR Rheumatoid Arthritis Classification Criteria Are Highly Sensitive in Patients with Early Rheumatoid Arthritis.

Chitale2,  Sarang, Goodson2,  Nicola J., Sharpley2,  David W., Thompson1,  Robert N., Moots2,  Robert J., Estrach2,  Cristina

Academic Rheumatology Department, University Hospital Aintree, Liverpool, Merseyside, United Kingdom
Academic Rheumatology Department, University of Liverpool, Liverpool, Merseyside, United Kingdom

Background:

Rheumatoid Arthritis (RA) requires early recognition & treatment with disease modifying anti-rheumatic drugs (DMARD) to prevent erosive damage and long-term disability. Many patients with early RA (eRA) do not satisfy the 1987 ACR classification criteria [1] at initial presentation. Other revised criteria have been proposed to improve the identification of such patients [2].

ACR and EULAR have jointly formulated new RA classification criteria, to facilitate early recognition of patients likely to have persistent and progressive disease and require DMARD therapy [3].

Aims:

To explore whether a cohort of patients with symptom duration >=12 months, diagnosed with eRA (based on the opinion of the rheumatologist) and started on DMARDS, met ACR-EULAR criteria at the initial assessment.

And to compare the percentage of patients diagnosed with RA at baseline by using 4 sets of criteria [1–3].

Methods:

Baseline data on patients with eRA attending between May 2006 and March 2010 were examined & included symptom duration, joint involvement (small & large), symmetry, early morning stiffness in minutes, swollen and tender joint counts out of 44 joints, radiographic changes, anti-CCP & rheumatoid factor (RF) status and titre and ESR & CRP at initial presentation. All patients had at least 1 clinically swollen joint at baseline.

1987 ACR criteria, ACR tree criteria [1], anti-CCP revised criteria and the new ACR-EULAR 2010 RA classification criteria were applied. A score of >=6 out of 10 by the ACR-EULAR criteria equals definite RA. Analysis was repeated for patients presenting with very early RA (veRA: defined as symptom duration <=3 months).

Results:

208 patients with eRA were identified, with mean age 58.7 years (SD 15.7 years) and median symptom duration of 16 weeks, IQR [9.5, 28 weeks]. 130 (62.5 %) were female, 123 (59%) tested positive for both RF & anti-CCP and 28 (13%) had radiographic erosive disease at baseline. 91 (44%) presented with veRA.

171 (82%) with eRA & 74 (81%) with veRA had definite RA by the ACR-EULAR RA classification criteria. Proportion of eRA & veRA patients satisfying each of the four sets of RA classification criteria at their initial rheumatology assessment is shown in Table 1.

Table 1. Number of eRA & veRA patients satisfying RA criteria at baseline rheumatology assessment

 eRA patients n=208veRA patients n=91
 n%n%
ACR 1987 criteria121584853
ACR Tree format142686167
Anti-CCP revised criteria (CCP-6)166806874
ACR-EULAR Definite RA (>=6 points)171827481

Conclusion:

This study demonstrates that the ACR-EULAR criteria are more sensitive for identifying RA at the initial rheumatology assessment than the other RA and eRA classification criteria in this EAC cohort.

This difference was most marked in those patients presenting with veRA, with the highest sensitivity for ACR-EULAR criteria. Applying these criteria in the EAC setting should facilitate more rapid initiation of DMARD therapy and has the potential to improve long-term outcomes for RA patients.

1.Arnett, FC et. al. Arthritis & Rheum 1988;31(3):31-4.

2.Liao, KP, et al. Ann Rheum Dis 2008; 67:155-1.

3.Aletaha,  et. al ACR-EULAR 2010 classification criteria. Submitted for publication

To cite this abstract, please use the following information:
Chitale, Sarang, Goodson, Nicola J., Sharpley, David W., Thompson, Robert N., Moots, Robert J., Estrach, Cristina; New 2010 ACR-EULAR Rheumatoid Arthritis Classification Criteria Are Highly Sensitive in Patients with Early Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1763
DOI: 10.1002/art.29528

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