2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative

Abstract

Abstract Objective The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. Methods A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease—this being the appropriate current paradigm underlying the disease construct “rheumatoid arthritis.” Results In the new criteria set, classification as “definite RA” is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0–5), serologic abnormality (score range 0–3), elevated acute‐phase response (score range 0–1), and symptom duration (2 levels; range 0–1). Conclusion This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late‐stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease‐suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct “rheumatoid arthritis.”

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Affiliated Institutions

• Université Paris Cité FR
• Harvard University US
• Assistance Publique – Hôpitaux de Paris FR
• University of Massachusetts Chan Medical School US
• University of Manchester GB
• Institute of Rheumatology CZ
• Human Genome Sciences (United States) US
• NIHR Leeds Musculoskeletal Biomedical Research Unit GB
• Amsterdam UMC Location University of Amsterdam NL
• University of Toronto CA
• Charité - Universitätsmedizin Berlin DE
• Swedish Medical Center US
• University of Kansas US
• National Jewish Health US
• California Pacific Medical Center US
• University of Amsterdam NL
• Hôpital Cochin FR
• Takeda (Japan) JP
• Humboldt-Universität zu Berlin DE
• Università Cattolica del Sacro Cuore IT
• Délégation Paris 5 FR
• New York University Langone Orthopedic Hospital US
• Bristol-Myers Squibb (Germany) DE
• Novartis (Switzerland) CH
• Array BioPharma (United States) US
• University of Colorado Denver US
• UMass Memorial Medical Center US
• Amgen (United States) US
• Merck Serono (Switzerland) CH
• Ministry of Health NZ
• Merck (Netherlands) NL
• Pfizer (United States) US
• Brigham and Women's Hospital US
• Women's College Hospital CA
• Leiden University Medical Center NL
• Diakonhjemmet Hospital
• McGill University Health Centre CA
• Merck (Germany) DE
• American College of Rheumatology US
• Boston University US
• ChemoCentryx (United States) US
• National Institute of Geriatrics, Rheumatology and Rehabilitation PL
• Erasmus MC NL
• The National Databank for Rheumatic Diseases US
• Biogen (United States) US
• Medical University of Vienna AT
• Abbott (United Kingdom) GB
• University of Pittsburgh US
• University of California, San Diego US
• University of Michigan US
• Pfizer (United Kingdom) GB
• Mount Sinai Hospital CA
• University of Leeds GB
• Johns Hopkins University US
• University of Washington US
• Eli Lilly (United States) US
• University of California, San Francisco US
• Sanofi (France) FR
• Roche (Switzerland) CH

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