We appreciate the comments by Dr. Chopra, and understand the issues involved in applying the new criteria in the developing world, particularly where expert rheumatologic assessment is not readily available. However, it is important to note that these criteria are intended for classification in clinical research and trials, not for diagnosis in clinical practice. As such, documentation of a history of synovitis needs to be based on the same level of robust assessment by an expert assessor; otherwise, for example, this would limit the extrapolation of such local research data to other populations, and would not be ideal in terms of recruitment to multicenter studies. Further, it would not be appropriate to apply the criteria if the rheumatologic opinion was that the arthritis was due to other conditions, such as infectious arthritis, which may be prevalent. As diagnostic criteria evolve from these new classification criteria, as we expect they will, the availability of “expert assessors” must be considered.
To the Editor:
Gillian Hawker MD, MSc, FRCPC*, Alan Silman FRCP, FmedSci, DSc (Hons), Daniel Aletaha MD, MSc, Tuhina Neogi MD, PhD, FRCPC§, * Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada, Arthritis Research UK, Chesterfield, UK, Medical University of Vienna, Vienna, Austria, § Boston University School of Medicine, Boston, MA.