Elsevier

Joint Bone Spine

Volume 82, Issue 1, January 2015, Pages 38-41
Joint Bone Spine

Original article
Validation of the 2010-ACR/EULAR – classification criteria using newly EULAR-defined erosion for rheumatoid arthritis on the very early arthritis community-based (VErA) cohort

https://doi.org/10.1016/j.jbspin.2014.03.008Get rights and content

Abstract

Objective

To validate the 2010-ACR/EULAR criteria for rheumatoid arthritis (RA), taking into account the recent EULAR definition of “erosive disease”, on the 310 patients comprising the very early arthritis cohort (VErA).

Methods

2010-criteria performances were tested by first strictly applying its three items successively: ≥ 1 clinical synovitis/another disease(s)/score ≥ 6/10), then the typical erosion grid without obtaining a score of ≥ 6 to diagnose RA. We tested successively: no erosion (S1), ≥ 1 erosion(s) (S2), EULAR-defined erosive disease (S3). Two gold standards were used: expert diagnosis at six years and EULAR erosive disease at two years.

Results

At inclusion, median age was 52 years; median RA duration 4.2 months. 2010-ACR/EULAR criteria, including EULAR-defined erosive disease applied at baseline, classified comparable numbers of patients as the 1987 criteria (P = 0.27). Using expert diagnosis at six years, more patients were classified as RA with S2 than 1987-ACR criteria (P < 0.04). In contrast, sensitivity and specificity indicated that 2010-ACR/EULAR–S3 criteria performed slightly but not significantly better than 1987-ACR criteria. On ROC curves, a score ≥ 6 correctly classified RA. When EULAR-defined erosion at two years was the gold standard, the 1987-ACR, the 2010-S1, -S2 and -S3 criteria performed comparably.

Conclusions

Using the very early community-based, conservatively treated VErA cohort, the strict application of 2010-ACR/EULAR criteria using the new EULAR definition of erosive disease or not performed slightly but not significantly better than the 1987-ACR criteria.

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;

References (16)

  • R. Inaoui et al.

    Outcome of patients with undifferentiated chronic monoarthritis: retrospective study of 46 cases

    Joint Bone Spine

    (2004)
  • D. Aletaha et al.

    2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism Collaborative Initiative

    Ann Rheum Dis

    (2010)
  • F.C. Arnett et al.

    The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis

    Arthritis Rheum

    (1988)
  • K.P. Liao et al.

    Anti-cyclic citrullinated peptide revised criteria for the classification of rheumatoid arthritis

    Ann Rheum Dis

    (2008)
  • X. Le Loët et al.

    Combining anti-cyclic citrullinated peptide with the American College of Rheumatology 1987 criteria failed to improve early rheumatoid arthritis diagnosis in the community-based very early arthritis cohort

    Rheumatology

    (2011)
  • H. Visser et al.

    How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis

    Arthritis Rheum

    (2002)
  • A.H. van der Helm-van Mil et al.

    Prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: how to guide individual treatment decisions

    Arthritis Rheum

    (2007)
  • D. van der Heijde et al.

    EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria

    Ann Rheum Dis

    (2013)
There are more references available in the full text version of this article.

Cited by (14)

  • MMP3 is a reliable marker for disease activity, radiological monitoring, disease outcome predictability, and therapeutic response in rheumatoid arthritis

    2018, Best Practice and Research: Clinical Rheumatology
    Citation Excerpt :

    Since 2010, multiple re-evaluations of the performance of the 2010 criteria were done. The results having a wide range of differences and controversies ranging from praising [93–96] to criticizing [97–102] and even concluding not adding to the 1987 criteria [97,102]. The 2010 criteria allow earlier diagnosis but may falsely diagnose self-limited or undifferentiated arthropathies [94,95,98,99,101].

  • Gene polymorphisms as predictors of response to biological therapies in psoriasis patients

    2016, Pharmacological Research
    Citation Excerpt :

    In the case of DAS28, the severity of the disease in 28 joints of the body is measured and swelling and pain is observed, also including levels of C Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) [15,16]. The ACR/EULAR classification criteria evaluate disease improvement based on number of swollen, tender joints, CRP levels and patient global assessment [17]. Drugs administered in psoriasis are aimed at different pathways of the immune system, to block the inflammatory response.

View all citing articles on Scopus
View full text