New RA Diagnostic Criteria & Early Treatment | Arthritis Information

 

COPENHAGEN, June 10 -- A forthcoming overhaul of diagnostic criteria for rheumatoid arthritis will allow physicians to identify patients who would benefit from disease-modifying drugs earlier in the disease process, leaders of the revision process said here.

They said greater use of blood tests in addition to familiar diagnostic clues such as tender and swollen joints would give clinicians a better idea of which patients genuinely have rheumatoid arthritis -- before the condition becomes chronic and irreversible joint damage sets in.

The revision, conducted by a joint task force assembled by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), is to be released at the former's annual meeting in Philadelphia this October, said Jonathan Kay, M.D., of Massachusetts General Hospital in Boston, the ACR's board liaison.

Dr. Kay was one of several prominent rheumatologists involved in the guideline overhaul who spoke at a progress-report session here at EULAR's annual meeting.

Alan Silman, M.D., of the University of Manchester in England, said the effort began following recognition that current official criteria -- developed in 1987 by the ACR -- rely too much on features such as joint erosion and subcutaneous nodules that reflect advanced disease.

The two groups are now winding up a two-pronged approach to revising the criteria to distinguish patients with rheumatoid arthritis from those with osteoarthritis or other conditions that may also produce joint pain and inflammation, but which respond to different treatments.

In one approach, ACR and EULAR put together a 22-member expert panel who, in a systematic process, attempted to define how clinicians identify patients who would benefit from methotrexate, the standard first-line drug for rheumatoid arthritis.

They conducted a series of structured case reviews, with their judgments combined in a decision-analysis model, said Gillian Hawker, M.D., M.Sc., of the University of Toronto.

The experts from both sides of the Atlantic were asked in each case how they evaluated the probability that the patient had rheumatoid arthritis, and whether they would recommend methotrexate treatment.

Although one more iteration of case review and model validation is planned, the effort has identified four major clinical domains that have the strongest influence on clinician judgment:

• Pattern and extent of joint involvement
• Duration of symptoms
• Blood levels of the acute-phase markers C-reactive protein and erythrocyte sedimentation rate
• Serological markers including rheumatoid factor and anti-citrullated protein antibodies

The decision analysis method has also identified categories within each domain that could form the basis for a diagnostic checklist, Dr. Hawker said.

Lynn492009-06-11 05:24:42Great find Lynn....this is a very interesting topic to me as I'm in the early stages of trying to figure out whether or not to start treatment. Going by the 1987 criteria, I only satisfy 1  out of 6 of the criteria (RF Factor)...have mild joint pain but no swelling. Thanks Lynn. It will be interesting to see how this plays out for seronegative patients.

[quote]...that members of the guidelines panels expect the new guidelines to make greater use of blood tests as well as standard diagnostic elements.[/quote]

It seems that the standard diagnostic elements are being 'tweaked' as well:

[quote]

Dr. Hawker said the expert consensus was that morning stiffness is helpful in diagnosing synovitis, but not for distinguishing rheumatoid from other forms of arthritis.

Dr. Silman emphasized the importance of early diagnosis as a precursor to early disease-modifying treatment.[/quote]

[QUOTE=Spelunker]Thanks Lynn. It will be interesting to see how this plays out for seronegative patients.

[quote]...that members of the guidelines panels expect the new guidelines to make greater use of blood tests as well as standard diagnostic elements.[/quote]

It seems that the standard diagnostic elements are being 'tweaked' as well:

[quote]

Dr. Hawker said the expert consensus was that morning stiffness is helpful in diagnosing synovitis, but not for distinguishing rheumatoid from other forms of arthritis.

Dr. Silman emphasized the importance of early diagnosis as a precursor to early disease-modifying treatment.[/quote]

[/QUOTE] I think ease of diagnosis comes from how you present...If the symptoms are cear cut then it doesn't matter whether one is sero negative or not.Thanks Lynn and buckeye. I was diagnosed on my first RD visit with sever onset inflammatory arthritis and on my second with RA and was, and remain, seronegative.

Presentation is the key.
I was sero-negative for years but with minimal presentations.  No one wanted to diagnose RA.  Then I had a severe onset and that clinched the diagnosis.  I wish that one of those doctors had been brave enough to say "you have RA".  It certainly will be easier for the newbies to be diagnosed and treated according to the new criteria if ALL of the RDs ascribe to the same set of criteria by the ACR.  Some just seem to do their own thing and it's at the expense of the patient.  LindyAs a newbie, I'm curious....is the ACR criteria setup to define when to start treatement? i.e. Is it suggested you have to meet ALL critiera before it is recommended to start taking medication? (in the case where the presentation is not typical).some drs may prescribe meds with "suspected" RA others will wait until a confirmed diagnosis..it really depends on how you present.  But don't forget you only need  out of 7 of the current criterea to get a diagnosis Thanks buckeye, went back and revisted the current criteria and found a classification tree that said diagnsosis can be confirmed if: RA invlolves red, swollen, inflamed joints but they may not be readily appearant in the early days....though the pain tends to be fairly specific
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