13th August - A new way of classifying rheumatoid arthritis (RA) could lead to earlier identification of the disease and enable patients to be treated much earlier, which will help prevent the disabling effects of the disease. If diagnosed early, disease-modifying antirheumatic medicines can prevent the destructive and disabling joint damage which is a hallmark of late-stage RA.
The revised classification, jointly announced by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR), will also allow researchers to recruit patients for clinical trials earlier in the disease process.
Immediate adoption into UK clinical practice
“It’s been very hard to get the message across that rheumatoid arthritis is almost a medical emergency and should be treated immediately,” and these new criteria will enable this, says Professor Paul Emory, president of EULAR. They will be adopted into clinical practice immediately in the UK and will have a “profound effect on outcomes for patients”, he adds. Many UK rheumatologists are already using this approach to diagnose patients with RA at an earlier stage, recognising that the old criteria were not working for these patients, Emery explains .
Rheumatoid arthritis is a progressive autoimmune inflammatory disease, which affects mainly the joints. If untreated, it leads to damage of bone and cartilage, joint deformities and disability. The condition affects approximately 350,000 people in the UK and occurs more frequently in women than men. It is most common after the age of 40, but it can affect people of any age. Late-stage rheumatoid arthritis has also been linked to a higher risk of serious heart disease and premature death.
Early diagnosis complicated
Early diagnosis of RA is complicated by the fact that its symptoms mimic those of other common conditions including osteoarthritis, gout, lupus and infection-related joint inflammation.
It has been almost 25 years since the classification criteria for RA have been updated. Since that time, much has been learned about the disease and new treatments have been introduced that can prevent the joint damage and bone erosion characteristic of advanced RA.
Under the old classification system many patients did not meet the definition for RA until joint damage was evident. “The 1987 criteria actually posed a major barrier to the study of treatments designed to prevent joint damage in RA,” explains Dr Gillian Hawker, senior author of the new criteria.
The new criteria appear in the September issues of Annals of the Rheumatic Diseases, published by the BMJ Group, and Arthritis & Rheumatism, the journal of the American College of Rheumatology.
10-point analysis
Under the new system, patients with inflamed joint linings with no other obvious cause will be evaluated for RA using a 10-point analysis that includes such factors as symptom duration and the number, site and size of the joints involved. A score of 6 or more out of 10 is needed for a classification of “definite RA”.
The new classification system includes a blood test for specific RA antibodies which is now widely used in clinical practice but did not exist when the old system was adopted.
Eliminated from the revised criteria is morning stiffness in the joints that lasts for at least one hour. “Morning stiffness is seen in inflammatory arthritis, but it is not specific for RA,” says Dr Tuhina Neogi, one of the co-authors. “It is not particularly helpful for predicting whether or not someone will end up with that diagnosis.”
source: www.webmd.boots.com
