The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report.
OBJECTIVE
The American College of Rheumatology and the European League Against Rheumatism have developed new classification criteria for rheumatoid arthritis (RA). The aim of Phase 2 of the development process was to achieve expert consensus on the clinical and laboratory variables that should contribute to the final criteria set.


METHODS
Twenty-four expert RA clinicians (12 from Europe and 12 from North America) participated in Phase 2. A consensus-based decision analysis approach was used to identify factors (and their relative weights) that influence the probability of "developing RA," complemented by data from the Phase 1 study. Patient case scenarios were used to identify and reach consensus on factors important in determining the probability of RA development. Decision analytic software was used to derive the relative weights for each of the factors and their categories, using choice-based conjoint analysis.


RESULTS
The expert panel agreed that the new classification criteria should be applied to individuals with undifferentiated inflammatory arthritis in whom at least 1 joint is deemed by an expert assessor to be swollen, indicating definite synovitis. In this clinical setting, they identified 4 additional criteria as being important: number of joints involved and site of involvement, serologic abnormality, acute-phase response, and duration of symptoms in the involved joints. These criteria were consistent with those identified in the Phase 1 data-driven approach.


CONCLUSIONS
The consensus-based, decision analysis approach used in Phase 2 complemented the Phase 1 efforts. The 4 criteria and their relative weights form the basis of the final criteria set.
Neogi
Tuhina
T
Boston University School of Medicine, Boston, Massachusetts, USA.
Aletaha
Daniel
D
Silman
Alan J
AJ
Naden
Raymond L
RL
Felson
David T
DT
Aggarwal
Rohit
R
Bingham
Clifton O
CO
Birnbaum
Neal S
NS
Burmester
Gerd R
GR
Bykerk
Vivian P
VP
Cohen
Marc D
MD
Combe
Bernard
B
Costenbader
Karen H
KH
Dougados
Maxime
M
Emery
Paul
P
Ferraccioli
Gianfranco
G
Hazes
Johanna M W
JM
Hobbs
Kathryn
K
Huizinga
Tom W J
TW
Kavanaugh
Arthur
A
Kay
Jonathan
J
Khanna
Dinesh
D
Kvien
Tore K
TK
Laing
Timothy
T
Liao
Katherine
K
Mease
Philip
P
Ménard
Henri A
HA
Moreland
Larry W
LW
Nair
Raj
R
Pincus
Theodore
T
Ringold
Sarah
S
Smolen
Josef S
JS
Stanislawska-Biernat
Ewa
E
Symmons
Deborah
D
Tak
Paul P
PP
Upchurch
Katherine S
KS
Vencovský
Jirí
J
Wolfe
Frederick
F
Hawker
Gillian
G
D000210:Acute-Phase Reaction / Q000150:complications / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D019963:Clinical Chemistry Tests; D032921:Consensus; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D005060:Europe; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D009656:North America; D012219:Rheumatology / Q000379:methods*; D012955:Societies, Medical; D013585:Synovitis / Q000150:complications / Q000473:pathology; D009626:Terminology as Topic