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A new way of classifying rheumatoid arthritis should lead to earlier identification of the disease, which, in turn, should help investigators explore new therapies to prevent its ravages, researchers say.

Aug. 11, 2010 -- A new way of classifying rheumatoid arthritis should lead to earlier identification of the disease, which, in turn, should help investigators explore new therapies to prevent its ravages, researchers say.

The revised classification, announced this week by the American College of Rheumatology and the European League Against Rheumatism, will allow researchers to recruit patients for clinical trials earlier in the disease process, says Boston University associate professor of medicine and epidemiology Tuhina Neogi, MD, PhD.

It may also lead to earlier treatment of some patients with suspected rheumatoid arthritis (RA), she says, although that was not the purpose of the revision.

The new criteria appear in the September issue of Arthritis & Rheumatism.

'It is likely that this will be adopted into clinical practice, but many other factors must be considered for a diagnosis of rheumatoid arthritis," Neogi tells WebMD. "The rheumatologist has to take into account the patient's specific risk factors and a whole host of other things. The process is very nuanced."

Early RA Diagnosis Is Difficult

An estimated 1.3 million people in the U.S. have rheumatoid arthritis. The disease strikes twice as many women as men.

RA is a progressive disease, mainly characterized by inflammation of the lining of the joints, but it can also affect other organs.

Early diagnosis of RA is complicated by the fact that its symptoms mimic those of other common conditions including osteoarthritis, gout, lupus, and infection-related joint inflammation.

It has been almost 25 years since the classification criteria for RA has been updated. Since that time much has been learned about the disease and new treatments have been introduced that can prevent the joint damage and bone erosion characteristic of advanced RA.

Under the old classification system many patients did not meet the definition for RA until joint damage was evident.

"The goal of today's treatments is to keep people from reaching the point where they have bone erosion and joint deformities," Neogi says.

Morning Stiffness Not Specific to RA

Under the new system, patients with inflamed joint linings with no other obvious cause will be evaluated for RA using a 10-point analysis that includes such factors as symptom duration and the number and size of the joints involved.

A score of 6 or more out of 10 is needed for a classification of "definite RA."

The new classification system includes blood testing for the RA antibody ACPA, which is now widely used in clinical practice but did not exist when the old system was adopted, Neogi says.

Eliminated from the revised criteria: morning stiffness in the joints that lasts for at least one hour.

"Morning stiffness is seen in inflammatory arthritis, but it is not specific for RA," Neogi says. "It is not particularly helpful for predicting whether or not someone will end up with that diagnosis."

The new system will help researchers better assess new treatments to prevent joint damage by increasing the pool of patients eligible for clinical trials before joint damage occurs, senior author Gillian Hawker, MD, says in a news release.

He says the next logical step would be to use these classification criteria to develop diagnostic guidelines to aid in the diagnosis of RA.

WebMD Health News 
by Salynn Boyles 
Reviewed By Laura Martin

Last Modified: 2010/8/11 下午 06:13:54

c 2010 WebMD, LLC. All rights reserved.

專家們表示，新的分類系統可以讓部分RA患者早些接受治療。

　　【24drs.com】Aug. 11, 2010 -- 研究人員表示，一項新的類風濕性關節炎分類方法可以早點偵測這個疾病，且接著可協助研究團隊發展避免此疾病帶來之損害的新治療。
　　
　　波士頓大學醫學與流行病學副教授Tuhina Neogi博士表示，這個修訂過的分類是由美國風濕醫學會以及歐洲抗風濕性疾病聯盟共同發表，將可讓研究團隊在疾病早期時收納病患進入臨床試驗。
　　
　　她指出，這也能讓部分懷疑罹患類風濕性關節炎（RA）的患者早一點接受治療，縱使這並不是改版的目的。
　　
　　這個新的診斷標準發表在9月號的關節炎與風濕性疾病期刊。
　　
　　Neogi博士向WebMD表示，很可能的，這個標準將會在臨床執業上應用，但是許多其他因子可能必須納入類風濕性關節炎的診斷。風濕性疾病專家們必須要考慮病患特定的危險因子，以及綜合考量，這個過程是非常微妙的。
　　
　　【早期診斷RA是困難的】
　　在美國，估計有130萬人罹患類風濕性關節炎；女性發生的比例是男性的兩倍。
　　
　　RA是一種進展性疾病，主要以關節內襯發炎表現，但是也可能影響其他器官。
　　
　　早期診斷RA會受到這些症狀與其他常見疾病相似而變得困難，包括骨關節炎、痛風、狼瘡以及感染相關發炎。
　　
　　上一次更新RA的分類條件已經是25年之前，從那時候到現在，我們已經學到許多有關疾病的知識，且發明了許多預防關節損傷及骨頭腐蝕的新治療，這些都是嚴重RA的特徵。
　　
　　在舊的分類系統，許多病患直到出現顯著的關節損傷，才符合RA定義。
　　
　　Neogi表示，現今的治療目標是讓人們免於發生骨頭腐蝕以及關節變形。
　　
　　【晨間關節僵硬並非RA的專一性表徵】
　　在新系統下，沒有其他原因可解釋的關節內襯發炎患者將會接受一項10分的RA評估，包括例如症狀時間長短以及侵犯到的關節數目與大小。要達到「確認RA」的分類需要10分超過6分。
　　
　　Neogi表示，這項新分類系統包括RA抗體ACPA的血液檢驗，現在廣泛地在臨床執業上使用，但是在發表舊系統時還沒有這項檢驗。
　　
　　有「持續一小時的關節晨間僵硬」條件，則從修訂後版本排除。
　　
　　Neogi表示，發炎性關節炎可見關節晨間僵硬，但是並非RA專有，這在預測哪些患者最終為RA診斷上幫助不大。
　　
　　資深作者Gillian Hawker在一篇新聞稿中表示，這個新系統將可以協助研究者們在關節損害發生之前，透過增加適合收納到臨床試驗的患者來評估預防關節損傷之新治療的好處。
　　
　　他指出，下一個合理的步驟將會是使用這些分類條件來發展協助診斷RA的指引。