title: 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.
abstract: OBJECTIVE
  The 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticised for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA.
  
  
  METHODS
  A joint working group from the ACR and the European League Against Rheumatism developed, in three phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease--this being the appropriate current paradigm underlying the disease construct 'RA'.
  
  
  RESULTS
  In the new criteria set, classification as 'definite RA' is based on the confirmed presence of synovitis in at least one joint, absence of an alternative diagnosis better explaining the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in four domains: number and site of involved joints (range 0-5), serological abnormality (range 0-3), elevated acute-phase response (range 0-1) and symptom duration (two levels; range 0-1).
  
  
  CONCLUSIONS
  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 minimise the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct 'RA'.
authors.affiliation: Arthritis Research UK, Copeman House, Chesterfield, UK. a.silman@arthritisresearchuk.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Aletaha
authors.forename: Tuhina
authors.initials: T
authors.lastname: Neogi
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Silman
authors.forename: Julia
authors.initials: J
authors.lastname: Funovits
authors.forename: David T
authors.initials: DT
authors.lastname: Felson
authors.forename: Clifton O
authors.initials: CO
authors.lastname: Bingham
authors.forename: Neal S
authors.initials: NS
authors.lastname: Birnbaum
authors.forename: Gerd R
authors.initials: GR
authors.lastname: Burmester
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Bykerk
authors.forename: Marc D
authors.initials: MD
authors.lastname: Cohen
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.forename: Karen H
authors.initials: KH
authors.lastname: Costenbader
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
authors.forename: Johanna M W
authors.initials: JM
authors.lastname: Hazes
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hobbs
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Arthur
authors.initials: A
authors.lastname: Kavanaugh
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kay
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.forename: Timothy
authors.initials: T
authors.lastname: Laing
authors.forename: Philip
authors.initials: P
authors.lastname: Mease
authors.forename: Henri A
authors.initials: HA
authors.lastname: Ménard
authors.forename: Larry W
authors.initials: LW
authors.lastname: Moreland
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Naden
authors.forename: Theodore
authors.initials: T
authors.lastname: Pincus
authors.forename: Josef S
authors.initials: JS
authors.lastname: Smolen
authors.forename: Ewa
authors.initials: E
authors.lastname: Stanislawska-Biernat
authors.forename: Deborah
authors.initials: D
authors.lastname: Symmons
authors.forename: Paul P
authors.initials: PP
authors.lastname: Tak
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Upchurch
authors.forename: Jirí
authors.initials: J
authors.lastname: Vencovsky
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
mesh_terms: D000210:Acute-Phase Reaction / Q000150:complications / Q000473:pathology; D000465:Algorithms; D001172:Arthritis, Rheumatoid / Q000145:classification* / Q000150:complications / Q000175:diagnosis*; D042241:Early Diagnosis; D005060:Europe; D006801:Humans; D007391:International Cooperation; D009656:North America; D012720:Severity of Illness Index; D012955:Societies, Medical; D013585:Synovitis / Q000150:complications / Q000473:pathology; D009626:Terminology as Topic; D013997:Time Factors