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| |  New Criteria May Better Classify Early Rheumatoid Arthritis ATLANTA, GA -- November 14, 2007 -- Changing the way in which rheumatoid arthritis is diagnosed by including one new assessment and excluding two current assessments may allow for the identification and inclusion of a larger number of patients with early disease in clinical studies, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston. The current classification criteria for RA are quite sensitive for patients with established disease. These criteria are primarily used for determining whether a patient qualifies to be included in a study of RA but are often used by clinicians for diagnostic purposes. Some of the current clinical and radiological findings in the RA criteria may not appear until the disease has been present for some time, and thus may not be as useful to classify or diagnose early RA. As the approach to managing rheumatoid arthritis shifts to treating patients earlier in the course of their disease, before joint damage and disability has begun, it is important to correctly identify patients with early disease, so that they can be included in assessments of new therapies. Investigators set out to assess the impact of including anti-CCP testing and excluding rheumatoid nodules and radiographic changes on the classification of early rheumatoid arthritis. To do so, they identified 391 subjects seen in the Arthritis Center of Brigham and Women's Hospital who were tested for both rheumatoid factor and antibodies to cyclic citrullinated peptide (anti-CCP) on the same day between January 1 and June 1, 2004. Based on analysis of these patients' electronic medical records, 99 patients were excluded and the records of 292 subjects were ultimately analyzed. The average age of subjects was 54 years old; 82% of them were women, and the average duration of symptoms was just over four years. Seventeen% of these patients had a positive rheumatoid factor, and 14% tested positive for anti-CCP at initial testing. By including anti-CCP testing and excluding rheumatoid nodules and radiographic changes, the number of patients correctly classified as having RA jumped from 51% to 74%. Applying these criteria sets to patients who have had symptoms for less than 6 months (when signs such as nodules and radiographic changes may not yet be apparent) demonstrated an even greater relative increase in the number of patients appropriately classified as having RA: from 25 to 63%. "Anti-CCP testing is now widely used in clinical practice to aid in the diagnosis of RA, but is not included in the current ACR criteria for the classification of RA. Additionally, RA therapies available today are able to slow or halt disease progression. It is important that new therapies are tested early in the disease course before significant damage has occurred," said Katherine P. Liao, MD, Brigham and Women's Hospital, Boston, Mass., and lead investigator in the study. "The current criteria for RA diagnosis include elements that may not become apparent until later in the disease. Minor modifications in these criteria may allow us to correctly identify RA patients earlier, when intervention may be more effective."
SOURCE: American College of Rheumatology
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