New Way to Classify Rheumatoid Arthritis

Experts Say New System Could Lead to Earlier Treatment of

Some RA Patients
By Salynn Boyles
WebMD Health News
Reviewed by Laura J. Martin, MD

Aug. 11, 2010 -- A new way of classifying rheumatoid arthritis should lead
to earlier identification of the disease, which, in turn, should help
investigators explore new therapies to prevent its ravages, researchers
say.

The revised classification, announced this week by the American College

of Rheumatology and the European League Against Rheumatism, will
allow researchers to recruit patients for clinical trials earlier in the disease
process, says Boston University associate professor of medicine and
epidemiology Tuhina Neogi, MD, PhD.

It may also lead to earlier treatment of some patients with suspected

rheumatoid arthritis (RA), she says, although that was not the purpose of
the revision.

The new criteria appear in the September issue of Arthritis & Rheumatism.

"It is likely that this will be adopted into clinical practice, but many other
factors must be considered for a diagnosis of rheumatoid arthritis," Neogi
tells WebMD. "The rheumatologist has to take into account the patient's
specific risk factors and a whole host of other things. The process is very
nuanced."

Slideshow: Understanding Rheumatoid Arthritis

Early RA Diagnosis Is Difficult

An estimated 1.3 million people in the U.S. have rheumatoid arthritis. The
disease strikes twice as many women as men.

RA is a progressive disease, mainly characterized by inflammation of the

lining of the joints, but it can also affect other organs.
Early diagnosis of RA is complicated by the fact that its symptoms mimic
those of other common conditions including osteoarthritis, gout, lupus, and
infection-related joint inflammation.

It has been almost 25 years since the classification criteria for RA has
been updated. Since that time much has been learned about the disease
and new treatments have been introduced that can prevent the joint
damage and bone erosion characteristic of advanced RA.

Under the old classification system many patients did not meet the
definition for RA until joint damage was evident.

"The goal of today's treatments is to keep people from reaching the point
where they have bone erosion and joint deformities," Neogi says.

Morning Stiffness Not Specific to RA

Under the new system, patients with inflamed joint linings with no other
obvious cause will be evaluated for RA using a 10-point analysis that
includes such factors as symptom duration and the number and size of the
joints involved.
A score of 6 or more out of 10 is needed for a classification of "definite
RA."
The new classification system includes blood testing for the RA antibody
ACPA, which is now widely used in clinical practice but did not exist when
the old system was adopted, Neogi says.

Eliminated from the revised criteria: morning stiffness in the joints that lasts
for at least one hour.

"Morning stiffness is seen in inflammatory arthritis, but it is not specific for

RA," Neogi says. "It is not particularly helpful for predicting whether or not
someone will end up with that diagnosis."
The new system will help researchers better assess new treatments to
prevent joint damage by increasing the pool of patients eligible for clinical
trials before joint damage occurs, senior author Gillian Hawker, MD, says
in a news release.

He says the next logical step would be to use these classification criteria to
develop diagnostic guidelines to aid in the diagnosis of RA.