New criteria for studying Rheumatoid Arthritis
Last October at their convention, the American College of Rheumatology unveiled the revised criteria for classification of Rheumatoid Arthritis (for more detail on how the point system works, please click that link). This month, in coordination with the European League Against Rheumatism (EULAR), they have announced that the new guidelines have been adopted in the September issue of Arthritis & Rheumatism. The final criteria seem to be equal to what was revealed last fall, with some additional wording.
As in the past, the criteria are technically created to be guidelines for the clinical classification of Rheumatoid Arthritis, especially for researchers and clinical trials. However, since IRL clinicians need some guidance too, the new criteria will be used in practice for diagnosis, just as the old ones were – at least until there is an alternative. It seems the criteria are of particular interest to insurance companies and governments who manage healthcare as well.
What’s next with new criteria for Rheumatoid Arthritis?
The next step is to create the first actual guidelines for diagnosis of Rheumatoid Arthritis. According to Laurie Barclay, MD for Medscape, the creators of the Rheumatoid Arthritis criteria “hope that development of this new set of classification criteria will further accelerate RA research. Dr. Hawker suggests that the next logical step should be to use these classification criteria to develop diagnostic criteria for RA, which could be used in rheumatology practice.” I also read some comments expressing concern that non-rheumatologists may be considered less equipped to use the guidelines. Perhaps new diagnostic guidance could also include some indicators for general physicians or for referral to rheumatologists. Let’s hope so.
Why do we need new criteria for Rheumatoid Arthritis?
The hope of everyone is that the new guidelines will increase treatment of Rheumatoid Arthritis by helping more patients to be identified earlier and receive coverage for the appropriate treatment. The 1987 ACR guidelines for Rheumatoid Arthritis were a description of later stage disease, as many now admit. “This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct ‘rheumatoid arthritis.’”
“Minimize the occurrence of the undesirable sequelae”? Did he mean “treat RA sooner so fewer of us need wheelchairs or joint replacements”? I thought so.
Many doctors have been practicing for years “outside” the guidelines by treating patients who obviously have Rheumatoid Arthritis, even though they do not present with RA that seems to fit the typical old conception. Some patients have been thanking God there are some doctors like this. However, other patients have gone untreated for years, suffering much damage, as many of you know too well. Here is what an ACR doctor said last fall when the new guidelines for Rheumatoid Arthritis were first revealed:
The new criteria “mirror what we are doing in practice, or what we think should be done in practice,” said Dr. Eric M. Ruderman, a rheumatologist at Northwestern University in Chicago who was not involved in creating the new criteria.
“At Northwestern, most of these patients are getting treated, but I’m not sure what goes on in the community,” Dr. Ruderman said in an interview. “The leading edge says ‘treat all patients who meet the new criteria.’ Will the rest of rheumatology follow that? It would probably have happened anyway, but [the new criteria] may help drive that” more quickly.
“We have patients with persistent, inflammatory arthritis who do not meet the current classification criteria but have persistent and functionally disabling disease. [The new criteria] set the stage for us to treat patients earlier,” said Dr. Weinblatt, professor of medicine at Harvard Medical School and codirector of clinical rheumatology at Brigham and Women’s Hospital, both in Boston. The new criteria “will allow more rapid institution of disease-modifying therapy.”
Editd 6/11/11: replace broken link.
Recommended: Details about why the changes are needed & what they mean:
- American College of Rheumatology Redefines Rheumatoid Arthritis
- American College of Rheumatology Redefines Rheumatoid Arthritis, Part 2
- American College of Rheumatology Redefines Rheumatoid Arthritis, Part 3
How would YOU describe classic RA? What about Classic Rheumatoid Arthritis?