2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative
2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative
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DOI：
10.1136/ard.2010.138461
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发表时间：
2010-09-01
影响因子：
27.4
通讯作者：
Hawker, Gillian
中科院分区：
文献类型：
--
作者：
Aletaha, Daniel;Neogi, Tuhina;Hawker, Gillian
目的1987年美国风湿病学会（ACR;前身为美国风湿协会）对类风湿关节炎（RA）的分类标准因缺乏早期疾病的敏感性而受到批评。这项工作进行了开发新的分类标准RA。方法从ACR和欧洲反风湿联盟的联合工作组开发，分三个阶段，一种新的方法来分类RA。这项工作的重点是确定，在新出现未分化炎性滑膜炎的患者中，最好区分那些持续性和/或糜烂性疾病高风险和那些不高风险的因素-这是疾病结构“RA”的适当当前范例。分类为“明确的RA”是基于至少一个关节中证实存在滑膜炎，没有更好地解释滑膜炎的替代诊断，以及总分达到6分或以上（可能的10分）从四个领域的个人得分：涉及关节的数量和部位（范围0-5），血清学异常（范围0-3），急性期反应升高（范围0-1）和症状持续时间（两个层次;结论这种新的分类系统通过关注与持续性和/或非持续性疾病相关的疾病早期特征，重新定义了目前的RA模式。或糜烂性疾病，而不是通过其晚期特征来定义疾病。这将重新关注早期诊断和有效疾病抑制治疗的重要需求，以预防或最大限度地减少目前构成疾病结构“RA”基础的范例的不良后遗症的发生。
Objective The 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticised 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 three 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 'RA'.Results In the new criteria set, classification as 'definite RA' is based on the confirmed presence of synovitis in at least one joint, absence of an alternative diagnosis better explaining the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in four domains: number and site of involved joints (range 0-5), serological abnormality (range 0-3), elevated acute-phase response (range 0-1) and symptom duration (two 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 minimise the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct 'RA'.