ACR/EULAR 2010 rheumatoid arthritis classification criteria
ACR/EULAR 2010 rheumatoid arthritis classification criteria
复制标题
DOI：
10.1093/rheumatology/kes279
复制
发表时间：
2012-12-01
期刊：
影响因子：
5.5
通讯作者：
Upchurch, Katherine S.
中科院分区：
文献类型：
--
作者：
Kay, Jonathan;Upchurch, Katherine S.
在过去的二十年里，我们对RA发病机制的理解取得了进展，特别是对促进滑膜炎症的细胞因子（例如TNF-α，IL-1和IL-6）的鉴定，已经导致了影响疾病过程本身的治疗过程，而不仅仅是缓解症状。反过来，重点已经转移到在疾病过程中足够早的干预，以防止炎症后的关节破坏。因此，在2010年，ACR和欧洲抗风湿联盟（EULAR）提出了修订的分类标准，强调在病程早期出现的RA特征，包括ACPA，一种预测侵袭性疾病的生物标志物。这些与1987年ARA标准形成对比，该标准将确诊的RA患者与其他形式的关节炎患者区分开来，并确定了晚期疾病患者。2010年ACR/EULAR标准的类别分为四个分类，每个分类都有分数：关节症状;血清学（包括RF和/或ACPA）;症状持续时间，是否< 6 weeks or >6周;和急性期反应物（CRP和/或ESR）。该标准是在一个三阶段的过程中开发的，首先是对患者队列进行分析，以确定哪些疾病特征说服临床医生开始MTX治疗，然后是基于共识的决定，并创建一个评分系统，预测哪些患者将继续发展为持续性和/或糜烂性疾病。
Advances in our understanding of the pathogenesis of RA over the past two decades, particularly the identification of cytokines that promote synovial inflammation (e.g. TNF-alpha, IL-1 and IL-6), have led to treatment courses that affect the disease process itself, beyond alleviation of symptoms. In turn, emphasis has shifted to intervention early enough in the disease course to prevent the joint destruction that follows inflammation. Accordingly, in 2010 the ACR and the European League Against Rheumatism (EULAR) put forward revised classification criteria emphasizing RA characteristics that emerge early in the disease course, including ACPAs, a biomarker that predicts aggressive disease. These were in contrast with the 1987 ARA criteria, which distinguished established RA patients from those with other forms of arthritis, and identified patients with later disease. The categories of the 2010 ACR/EULAR criteria are grouped into four classifications, with point scores for each: joint symptoms; serology (including RF and/or ACPA); symptom duration, whether < 6 weeks or > 6 weeks; and acute-phase reactants (CRP and/or ESR). The criteria were developed in a three-phase process, beginning with an analysis of patient cohorts to determine what disease characteristics had persuaded clinicians to initiate MTX therapy, followed by consensus-based decisions and the creation of a scoring system that would predict which patients would go on to develop persistent and/or erosive disease.