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

Authors

  • Daniel Aletaha,

    1. Medical University of Vienna, Vienna, Austria
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    • Dr. Aletaha has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, UCB, Schering-Plough, Wyeth, and Roche (less than $10,000 each).

  • Tuhina Neogi,

    1. Boston University School of Medicine, Boston, Massachusetts
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  • Alan J. Silman,

    Corresponding author
    1. Arthritis Research UK, Chesterfield, UK
    • Arthritis Research UK, Copeman House, Chesterfield S41 7TD, UK
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  • Julia Funovits,

    1. Medical University of Vienna, Vienna, Austria
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  • David T. Felson,

    1. Boston University School of Medicine, Boston, Massachusetts
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  • Clifton O. Bingham III,

    1. Johns Hopkins University, Baltimore, Maryland
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    • Dr. Bingham has received consulting fees, speaking fees, and/or honoraria from UCB, Roche, Genentech, Celgene, and Merck Serono (less than $10,000 each); he has received research and/or educational grant support from Bristol-Myers Squibb, Genentech, UCB, Centocor, Abbott, and Amgen.

  • Neal S. Birnbaum,

    1. California Pacific Medical Center and University of California, San Francisco
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    • Dr. Birnbaum has received consulting fees, speaking fees, and/or honoraria from Amgen, Pfizer, Centocor, Abbott, and UCB (less than $10,000 each).

  • Gerd R. Burmester,

    1. Charité Hospital–University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
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    • Dr. Burmester has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, Pfizer, UCB, and Roche (less than $10,000 each).

  • Vivian P. Bykerk,

    1. Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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    • Dr. Bykerk has received consulting fees, speaking fees, and/or honoraria from Amgen, Wyeth, Abbott, Schering-Plough, Roche, Bristol-Myers Squibb, and UCB (less than $10,000 each); her spouse is employed by Genzyme and owns stock in the company.

  • Marc D. Cohen,

    1. National Jewish Medical and Research Center, Denver, Colorado
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    • Dr. Cohen has received consulting fees, speaking fees, and/or honoraria from UCB, Genentech, Bristol-Myers Squibb, and Human Genome Sciences (less than $10,000 each).

  • Bernard Combe,

    1. Lapeyronie Hospital and Montpellier I University, Montpellier, France
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    • Dr. Combe has received consulting fees, speaking fees, and/or honoraria from Abbott, Bristol-Myers Squibb, Pfizer, Roche, Schering-Plough, and Merck, Sharpe, and Dohme (less than $10,000 each).

  • Karen H. Costenbader,

    1. Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
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  • Maxime Dougados,

    1. Cochin Hospital, Assistance Publique Hôpitaux de Paris, and Paris-Descartes University, Paris, France
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  • Paul Emery,

    1. University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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    • Dr. Emery has received consulting fees, speaking fees, and/or honoraria from Pfizer, Abbott, Centocor, UCB, Roche, Bristol-Myers Squibb, and Merck, Sharpe, and Dohme (less than $10,000 each).

  • Gianfranco Ferraccioli,

    1. School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
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    • Dr. Ferraccioli holds a patent for T cell receptor clonotype analysis (PCT/IB 2008/053152 NP).

  • Johanna M. W. Hazes,

    1. Erasmus Medical Center, University Medical Center Rotterdam, and University of Rotterdam, Rotterdam, The Netherlands
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  • Kathryn Hobbs,

    1. University of Colorado School of Medicine, Denver
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  • Tom W. J. Huizinga,

    1. Leiden University Medical Centre, Leiden, The Netherlands
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    • Dr. Huizinga has received consulting fees, speaking fees, and/or honoraria from Schering-Plough, Bristol-Myers Squibb, UCB, Biotest AG, Wyeth/Pfizer, Novartis, Roche, Sanofi-Aventis, Abbott, and Axis-Shield (less than $10,000 each).

  • Arthur Kavanaugh,

    1. University of California, San Diego
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    • Dr. Kavanaugh has conducted clinical research for Amgen, Abbott, Bristol-Myers Squibb, UCB, Roche, Centocor, Genentech, and Sanofi-Aventis.

  • Jonathan Kay,

    1. UMassMemorial Medical Center and University of Massachusetts Medical School, Worcester
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    • Dr. Kay has received consulting fees from Array BioPharma, Bristol-Myers Squibb, Celgene, Centocor, Genentech, Roche, UCB, and Sanofi-Aventis (less than $10,000 each).

  • Tore K. Kvien,

    1. Diakonhjemmet Hospital, Oslo, Norway
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  • Timothy Laing,

    1. University of Michigan, Ann Arbor
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  • Philip Mease,

    1. Swedish Medical Center and University of Washington, Seattle
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    • Dr. Mease has received consulting fees, speaking fees, and/or honoraria from Abbott, Amgen, Biogen Idec, Bristol-Myers Squibb, Centocor, Roche, Genentech, UCB, Pfizer, Novartis, and Eli Lilly (less than $10,000 each).

  • Henri A. Ménard,

    1. McGill University Health Centre and McGill University, Montreal, Quebec, Canada
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    • Dr. Ménard has received unrestricted educational and research grants as well as consulting and speaking fees from Abbott, Amgen, Inova, Merck, Pfizer, Roche, Schering-Plough, UCB, and Wyeth (less than $10,000 each) and investigator-initiated research grants from Bristol-Myers Squibb, EuroImmun AG, and Roche (more than $10,000 each); he owns stock or stock options in Merck; and he has a license agreement with EuroImmun AG for an anti-Sa enzyme-linked immunosorbent assay.

  • Larry W. Moreland,

    1. University of Pittsburgh, Pittsburgh, Pennsylvania
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    • Dr. Moreland has received consulting fees, speaking fees, and/or honoraria from Biogen Idec, Centocor, Pfizer, Takeda, KaloBios, ChemoCentryx, UCB, Genentech, Incyte, and Eli Lilly (less than $10,000 each).

  • Raymond L. Naden,

    1. Ministry of Health, Auckland, New Zealand
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    • Dr. Naden has received consulting fees from the American College of Rheumatology in regard to the methodology of developing weighted scoring systems (more than $10,000).

  • Theodore Pincus,

    1. New York University Hospital for Joint Diseases, New York, New York
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    • Dr. Pincus has received consulting fees, speaking fees, and/or honoraria from Amgen, Abbott, Bristol-Myers Squibb, Centocor, UCB, Wyeth, and Genentech (less than $10,000 each) and investigator-initiated research grants from Amgen, Bristol-Myers Squibb, UCB, and Centocor.

  • Josef S. Smolen,

    1. Medical University of Vienna, Vienna, Austria
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  • Ewa Stanislawska-Biernat,

    1. Institute of Rheumatology, Warsaw, Poland
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    • Dr. Stanislawska-Biernat has received speaking fees from Abbott and Pfizer (less than $10,000 each).

  • Deborah Symmons,

    1. University of Manchester, Manchester, UK
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  • Paul P. Tak,

    1. Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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  • Katherine S. Upchurch,

    1. UMassMemorial Medical Center and University of Massachusetts Medical School, Worcester
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  • Jiří Vencovský,

    1. Institute of Rheumatology, Prague, Czech Republic
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    • Dr. Vencovský has received speaking fees from Pfizer, UCB, Abbott, Roche, and Merck, Sharpe, and Dohme (less than $10,000 each).

  • Frederick Wolfe,

    1. National Data Bank for Rheumatic Diseases and University of Kansas, Wichita
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  • Gillian Hawker

    1. Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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  • This article is published simultaneously in the September 2010 issue of Annals of the Rheumatic Diseases.

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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