Rheumatoid arthritis classifi cation criteria : an American College of Rheumatology / European League Against Rheumatism collaborative initiative
Rheumatoid arthritis classifi cation criteria : an American College of Rheumatology / European League Against Rheumatism collaborative initiative
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发表时间：
2010
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通讯作者：
D. Aletaha;T. Neogi;A. Silman;Julia Funovits;D. Felson;C. Bingham;N. Birnbaum;G. Burmester;V. Byker
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作者：
D. Aletaha;T. Neogi;A. Silman;Julia Funovits;D. Felson;C. Bingham;N. Birnbaum;G. Burmester;V. Byker
由美国风湿病学会和欧洲风湿病联盟支持。摘要目的1987年美国风湿病学会(ACR；原美国风湿病协会)的类风湿关节炎(RA)分类标准因对早期疾病缺乏敏感性而受到批评。这项工作是为了制定新的类风湿关节炎分类标准。方法由ACR和欧洲风湿病联盟组成的联合工作组分三个阶段制定了一种新的类风湿性关节炎分类方法。这项工作的重点是，在新出现的未分化炎性滑膜炎患者中，找出最能区分那些有持续性和/或侵蚀性疾病高风险的患者和那些没有高风险的患者的因素--这是当前疾病构建‘RA’的适当范例。结果在新的标准集中，根据至少一个关节存在滑膜炎，没有更好地解释滑膜炎的替代诊断，以及从受累关节的数量和位置(范围0-5)、血清学异常(范围0-3)、急性时相反应升高(范围0-1)和症状持续时间(两个级别；范围0-1)四个领域的单项评分中获得6分或更高(可能的10分)，将其归类为“Defi nite RA”。结论新的类风湿性关节炎分类系统重新定义了目前的类风湿性关节炎的分类模式，侧重于疾病早期阶段与持续性和/或侵袭性疾病相关的特征，而不是以疾病的晚期特征来定义疾病。这将使人们的注意力重新集中在早期诊断和建立有效的疾病抑制治疗的重要需要上，以防止或最大限度地减少不良后遗症的发生，这些后遗症目前构成了疾病结构‘RA’的基础范例。
Supported by the American College of Rheumatology and the European League Against Rheumatism. ABSTRACT Objective The 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classifi cation criteria for rheumatoid arthritis (RA) have been criticised for their lack of sensitivity in early disease. This work was undertaken to develop new classifi cation 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 infl ammatory 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, classifi cation as ‘defi nite RA’ is based on the confi rmed 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 classifi cation system redefi nes 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 defi ning 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’.