Consensus was achieved by the joint working group of the American College of Rheumatology (ACR, the former American Rheumatism Association) and the European League Against Rheumatism (EULAR).
Criteria published in the official journals of both organizations - Arthritis and Rheumatism (2010; 62:2569-81) and the Annals of the Rheumatic Diseases (2010; 69:1580-8), respectively, were created in three stages over two years.
Work focused on identifying the patients with recently appeared undifferentiated synovitis factors that best distinguishing those who have a high risk of developing persistent and / or erosive forms of disease.
The new scale diagnostic assigns points as follows:
- One of the affected "big joints (shoulders, elbows, hips, knees and ankles) receives a score of 0, 2.10 part of large joints gets 1 point.
- Involvement of 1-3 "small joints (phalanx, proximal interphalangeal, from second to fifth metatarsophalangeal joints, interphalangeal sustavoa fingers and wrist) gets 2 points, regardless of the involvement of large joint's involvement of small joints of 4.10 gets just 3 points.
- The interest of more than 10 joints, including at least one large, gets 5 points.
- And a negative rheumatoid factor (RF) and a negative test for autoantibodies (anti-citrullin protein antibody test, ACPA) together receive 0 points, while the "weakly positive" RF or ACPA (defined as less than three times the upper limit standards) get 2 points. For either of the two indicators is charged 3 points.
- Normal CRP and ESR receive a "0," while at least one positive test gets 1 point.
- Duration of the presence of symptoms less than six weeks gets a score of 0, the duration of six weeks or more - 1 point.
Dr. Eric L. Matteson, a professor of medicine in the department of rheumatology at the Mayo Clinic in Rochester, Minn. did not participate in the study, commenting in an interview with the online edition of Internal Medicine News new standards said: "The main useful feature is that the new criteria do not require the presence of several affected joints for the decision of early diagnosis of inflammatory rheumatoid arthritis.
Moreover, the patient can gain 6 points and no plural inflammation of the joints, in accordance with the new approach.
The authors noted that the symmetry of the lesion is not a criterion for diagnosis, as this symptom does not show the value at any stage of development criteria. Nevertheless, they wrote: "... inevitably greater the number of involved joints - probability of bilateral lesions.
When Dr. Matteson asked what are the drawbacks is a new criterion - he pointed to a lack of awareness (the authors) on extra particular RA components, which can also occur in the early stages of the disease.
"When they are, they can be very useful for the detection of the disease, and they are important markers of disease severity and symptoms and need treatment," - he said.
The new guidelines are also available biomarkers to assess the efficiency of a treatment, he added.
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