Friday, February 3, 2012
Evaluation and diagnosis in arthritis of recent onset
ACR/EULAR Rheumatoid Arthritis (RA) 2010 classification criteria (1) have been used to encourage earlier treatment (often including biologics) of RA. Early treatment with a regimen that may alter disease progression is a reasonable and in fact desirable ambition but are we at risk of treating some percentage of patients who do not have a potentially progressive RA? Alves et al (2) calculated that as many as 30% of patients could be unnecessarily aggressively treated. These new criteria give lip service to excluding other diseases but do not advise how to do that. One concern is that there is no requirement to aspirate and analyze even an obvious joint effusion. Might this be further evaluated? What is your experience? We have seen patients eventually proved to have gout who were treated elsewhere with anti-TNF agents for “RA”. With earlier ACR criteria we had shown that analyzing SF did change diagnoses (3).
1. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:259-81;2010
2. Alves C, Liume JJ, van Zeben D, et al. Diagnostic performance of the ACR/EULAR 2010 criteria for rheumatoid arthritis and two diagnostic algorithms in an early arthritis clinic (REACH). Ann Rheum Dis, 70:1645-7;2011. Epub 2011 May 7
3. Levin RW, Park J, Ostrov B,, et al. Clinical assessment of the 1987 American College of Rheumatology criteria for Rheumatoid Arthritis. Scand J Rheumatol 25:277-281;1996