Original articleValidation of the 2010-ACR/EULAR – classification criteria using newly EULAR-defined erosion for rheumatoid arthritis on the very early arthritis community-based (VErA) cohort
Introduction
Very early diagnosis and appropriate treatment of rheumatoid arthritis (RA) is now a major goal [1]. The 1987 criteria and their modified versions inadequately classified early stage RA [2], [3], [4]. Consequently, algorithms were constructed to predict high risk of persistent and/or erosive disease [5], [6]. An American College of Rheumatology/European League against Rheumatism (ACR/EULAR) task force published new 2010 classification criteria for early RA [1]. In those criteria, the definition of “erosive disease typical of RA” was not clear. Very recently, a EULAR task force proposed a clear definition of erosion status [7]. 2010-ACR/EULAR–classification criteria were based on nine early arthritis cohorts. The objective was to identify, among undifferentiated arthritis, those at high risk for persistent and/or erosive disease, as this paradigm underlies what we commonly call “RA”. The gold standard was starting methotrexate within the first 12 months [1]. Before these new criteria and the new definition of “erosive disease” can be used in practice, their performances must be evaluated on independent cohorts. To assure their robustness, these criteria must be tested on cohorts with different disease probabilities. This study was undertaken to validate the 2010-ACR/EULAR criteria, taking into account the new EULAR definition of erosive disease, on the independent, community-based, very early arthritis (VErA) cohort.
Section snippets
Methods
The VErA cohort was described previously [8]. Briefly, this community-based, inception cohort was recruited between 1998 and 2002 in two French regions. It comprised 310 patients: male or female, age ≥ 18 years; ≥ 2 swollen joints, swelling persisting for > 4 weeks, symptoms lasting < 6 months; no previous glucocorticoid prescription [only one intra-articular injection > 1 month before or oral prednisone (<10 mg/day) for 1 week > 2 weeks before enrollment were tolerated] or disease-modifying
Results
At inclusion (n = 310), median [range] patient age was 52 [19–84] years, with a median of 4.2 [0.9–6] months since symptom onset; 68.1% were female. All patients had ≥ 2 synovitis; 52 (16.8%) were erosive. Median values of relevant parameters were as follows: numbers of painful joints 6/68 [0–58], with 7/66 [2–37] swollen joints; Disease Activity Score-28 (DAS) was 2.95 [0.45–7.53]; erythrocyte sedimentation rate 18 [1–110] mm 1st hour; and C-reactive protein 7 [5–206] mg/L. No patient with a
Discussion
Our VErA cohort is community-based, meaning that it is representative of very early arthritis, notably undifferentiated arthritis, recruited from the general population, mainly by general practitioners. Testing the new 2010-ACR/EULAR–classification criteria on this type of population is highly relevant [8]. VErA patients’ diseases were less active and severe than those of the cohorts that served to elaborate and validate the 2010 criteria (data not shown). Unlike the single affected joint that
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgments
All the patients and investigators of the VErA cohort are warmly thanked. The authors also thank Janet Jacobson for editorial assistance and Sandrine Parisse for typing the manuscript.
Name of the institution(s): Departments of Rheumatology, Rouen University Hospital, Amiens University Hospital and Le Havre Hospital; Department of Biostatistics, Rouen University Hospital, Rouen, France; Inserm U 905, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Rouen, France;
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