Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


The 2010 Rheumatoid Arthritis Criteria Versus the 1987 Rheumatoid Arthritis Criteria: Will the Real Criteria Please Stand up!

Patel1,  Aarat M., Amity2,  Christine L., Frydrych2,  Lynne M., Sippel2,  Derek, Jones2,  Donald, Goudeau2,  Danielle, Eng3,  Heather

Univ of Pittsburgh Med Ctr/Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Univ of Pittsburgh Med Ctr, Pittsburgh, PA
Univ of Pittsburgh, Pittsburgh, PA
Brigham & Womens Hospital, Boston, MA
University of Pittsburgh, Pittsburgh, PA

Background/Purpose:

The 1987 American College of Rheumatology (ACR) classification criteria for Rheumatoid Arthritis (RA) was revised in 2010 by the ACR/European League Against Rheumatism (EULAR) to identify patients with earlier disease and to incorporate anti-cyclic citrullinated peptide (anti-CCP) results. Our aim was to evaluate the usefulness of the 2010 ACR/EULAR RA classification criteria for identification of RA in a large cross-sectional cohort and to determine the characteristics of those that do not fulfill the new criteria.

Methods:

We conducted an analysis of the Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry (N=606) to determine whether subjects met the 1987 and/or 2010 RA classification criteria. Subjects enrolled in RACER have RA based on the judgment of a treating physician and a second reviewer. Clinical data from the registry including age, sex, race, disease duration, disease activity score-28 joint count (DAS28), clinical disease activity index (CDAI), and laboratory measures (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and anti-CCP) were compared between groups. All variables of each criterion were compared for differences between groups. Statistical analysis was performed with Kruskal-Wallis and Pearson Chi-Square tests.

Results:

The majority of RACER subjects met both classification criteria (88.3%) (see Table). The rest met either "1987 only" (4.6%), "2010 only" (4.5%), or neither criteria (1.8%). There were no significant differences between groups in demographics, disease activity (DAS28 and CDAI) and CRP but there were marked differences in disease duration, ESR, RF, and anti-CCP. There were significant differences between the "1987 only" and "2010 only" groups in morning stiffness (85% vs 7%; p=0.0120), having >10 joints affected (0% vs 52%; p<0.0001) and anti-CCP positivity (9% vs 58%; p<0.0001).

Table 1. Group Comparison of Each Domain of the 1987 and 2010 Rheumatoid Arthritis Criteria in RACER subjects (n=606)

 Patients meeting 1987 and 2010 criteria (n=535)Patients meeting 1987 criteria only (n=33)Patients meeting 2010 criteria only (n=27)Patients meeting Neither criteria (n=11)P value
RF, Positive92%25%15%36%<0.0001
   Mean ±SD285.1 ± 663.413.54 ± 13.213.0 ± 13.223.3 ± 31.3<0.0001
   Median84555 
CCP, Positive83%9%58%27%<0.0001
   Mean ±SD235.9 ± 382.23.6 ± 4.8110.2 ± 218.427.7 ± 74.1<0.0001
   Median100213.52 
ESR, Abnormal59%32%39%20%0.003
   Mean ±SD38.7 ± 29.824.3 ± 26.527.8 ± 32.823.8 ± 32.60.002
   Median33161112 
CRP, Abnormal55%48%48%45%0.73
   Mean ±SD2.56 ± 4.711.23 ± 1.81.32 ± 2.091.24 ± 1.580.04
   Median0.900.640.450.70 
2010,1 large joint64%64%59%64%0.978
   2–10 large joints59%61%52%73%0.691
   1–3 small joints100%100%93%73%<0.0001
   4–10 small joints85%85%74%45%0.003
   >10 joints38%0%52%0%<0.0001
   >=6 weeks99%100%100%91%0.154
1987,>=3 joints99%100%89%82%<0.0001
   Hand arthritis99%97%89%55%<0.0001
   Symmetric98%100%85%73%<0.0001
   Morn.stiffness37%85%7%27%0.012
   Nodules14%0%0%0%<0.0001
   Rad. changes38%27%4%0%<0.0001
RACER: Rheumatoid Arthritis Comparative Effectiveness Research; SD: standard deviation; RF: rheumatoid factor (IU/ml); CCP: Anti-cyclic citrullinated protein antibody (EU); ESR: erythrocyte sedimentation rate (mm/hr); CRP: C-reactive protein (mg/dL)

Conclusion:

Our patients represent a "real world" RA cohort with a wide-range of disease duration and variable disease activity. Patients not fulfilling the 2010 criteria tended to have a low number of joints affected and seronegative disease. The differences between groups are due to the individual features of each criterion as some domains (morning stiffness, markers of longer disease duration (nodules and x-ray changes)) are not captured in the 2010 criteria and likewise some features are not captured in the 1987 criteria (anti-CCP). Our results support the idea that studies should consider using both criteria since a subset of patients with what would be defined as RA using the 1987 criteria would be missed if the 2010 criteria were used exclusively.

To cite this abstract, please use the following information:
Patel, Aarat M., Amity, Christine L., Frydrych, Lynne M., Sippel, Derek, Jones, Donald, Goudeau, Danielle, et al; The 2010 Rheumatoid Arthritis Criteria Versus the 1987 Rheumatoid Arthritis Criteria: Will the Real Criteria Please Stand up! [abstract]. Arthritis Rheum 2011;63 Suppl 10 :135
DOI:

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