New Classification Criteria for Rheumatoid Arthritis / 대한내과학회지

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness, and the destruction of bone and joints. It also has multiple systemic manifestations, resulting in functional disability and premature mortality. Since the introduction of various disease-modifying anti-rheumatic drugs and new biological agents, early diagnosis and treatment of this disease has become the most important therapeutic strategy. However, the existing classification criteria for RA, the 1987 revised American College of Rheumatology (ACR) classification criteria for RA, have limited diagnostic accuracy for early RA. Therefore, new classification criteria that include early RA are needed. Consequently, a joint working group of the ACR and European League Against Rheumatism (EULAR) was formed to develop a new approach to the classification for RA and developed the 2010 ACR/EULAR classification criteria. This review describes the content and clinical importance of these new classification criteria.

The Role of Bone Scintigraphy in the Diagnosis of Rheumatoid Arthritis According to the 2010 ACR/EULAR Classification Criteria

We aimed to investigate the role of bone scintigraphy (BS) in the diagnosis of rheumatoid arthritis (RA) as a supplement to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. A total of 156 patients who underwent BS with screening laboratory to confirm RA were enrolled. We divided them into two groups according to the presence of arthritis upon the first physical examination, and evaluated the diagnostic validity of BS as an independent (BS only) or assistant diagnostic tool using the 2010 criteria (BS-assisted). Seventy-five patients had active arthritis (Group I), while the remaining 81 patients did not (Group II). Among them, 56 patients in group I and 5 patients in group II were finally classified as RA. In the group I patients who were eligible for application of the 2010 criteria, the sensitivity of the BS only and BS-assisted diagnosis was not superior to that of the 2010 criteria. However, BS-assisted diagnosis showed high positive prediction values in group I patients with 2010 criteria score < 6 and group II patients. Therefore, BS is still helpful to detect RA even after the introduction of the 2010 criteria, especially among patients who do not satisfy the 2010 criteria as well as those who are ineligible for the 2010 criteria due to dubitable arthritis at clinical presentation.