Comparison of the 2010 American College of Rheumatology/European League Against Rheumatism and the 1987 American Rheumatism Association classification criteria for rheumatoid arthritis in an early arthritis cohort in New Zealand.

OBJECTIVE: To compare the performance of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria with the 1987 American Rheumatism Association (ARA) criteria for rheumatoid arthritis (RA) in an early arthritis cohort. METHODS: The study included 79 patients with early arthritis (symptoms < 12 months) and a minimum of 1 year of followup between January 2004 and August 2010. Case notes were reviewed to determine which criteria were fulfilled at initial, 3-month, 1-year, and 2-year visits. Requirements for disease-modifying antirheumatic drug (DMARD) therapy and presence of joint erosions were compared at 2 years. RESULTS: At the initial visit, twice as many patients fulfilled the 2010 criteria (67%) compared with the 1987 criteria (34%; p < 0.001). Forty-four percent of patients who fulfilled only the 2010 criteria at the initial visit went on to fulfill both 1987 and 2010 criteria at 3 months (p < 0.001). Eight patients did not meet the 1987 RA criteria solely because of short symptom duration. All 17/79 patients who developed joint erosions went on to eventually fulfill both criteria. Of those patients who fulfilled only the 2010 criteria at baseline, 25/27 (93%) ultimately received DMARD therapy compared with 24/26 (92%) of those fulfilling both 1987 and 2010 criteria. CONCLUSION: The 2010 ACR/EULAR RA criteria allowed earlier RA classification compared to the 1987 ARA criteria, although both criteria were equivalent in predicting joint erosions and subsequent need for DMARD (Australian New Zealand Clinical Trials Registry ANZCTR 12608000292370).

The Christchurch earthquake--providing a rheumatology service during a natural disaster.

To report on the effects of the Canterbury earthquake on rheumatology service provision and identify factors that allowed continuation of patient care. Data was collected on the number of appointments during the period after the earthquake and the effects of the earthquake on service provision. The rheumatology service faced unique challenges in continuing to provide a service and ensure ongoing care for our patients in the community after the earthquake. All outpatient services were cancelled for 2 weeks, resulting in the cancellation of 23 new patient and 145 follow-up patient appointments. Telephone consultation was attempted for all these patients. A total of 113 patients could be contacted, and 15 required acute review. Challenges included difficult access to the hospital, lack of laboratories for blood testing, limited access to clinical records, loss of power, sewerage and waste water and a contaminated drinking water supply. The impact of these on patients with rheumatic diseases was wide ranging. Despite a natural disaster and challenging logistics, the Rheumatology Department was able to provide a service with the use of remote telephone consultations and an electronic patient record backed up by an effective patient and primary practitioner education base and resource access.