Investigators looked for features present initially that helped predict later definite RA. 2010 62:2569-81) were developed through longitudinal follow-up of a cohort of patients who presented with an inflammatory arthritis that didn’t meet the 1987 criteria for RA. If you delay more than 3 or 4 months after symptom onset, your response to disease-modifying antirheumatic therapy is worse," he said. "The window for intervention is actually quite small. The impetus for developing the 2010 criteria was a persuasive body of evidence that in order to maximize outcomes physicians need to intervene earlier in the disease process than was possible using the 1987 criteria. Those are highly specific features of long-standing RA, but they’re not helpful in identifying patients with early disease. The 1987 criteria required radiographic evidence of erosions as well as the presence of subcutaneous rheumatoid nodules. But among the subset of patients with at least one swollen joint who fulfill the 2010 criteria, the spontaneous remission rate appears to be much lower, on the order of 10% ( Arthritis Rheum. Kolfenbach, a rheumatologist at the university.Īnd then there’s the whole squirrelly matter of transient joint swelling.Īmong patients with one or more swollen joints and no obvious etiology for their arthritis, the spontaneous remission rate approaches 50%. When rheumatologists took the time to first remove the cases they thought likely to be something other than RA, however, the false-positive rate using the 2010 criteria fell to 9%, noted Dr. It has been demonstrated that if the 2010 RA criteria are applied without first ruling out conditions including gout, lupus, and sarcoid, the false-positive rate, even in rheumatologists’ hands, is roughly 20%. Second, any alternative diagnoses that might better explain an individual’s synovitis must first be ruled out. First, the patient has to have at least one swollen joint joint pain without swelling isn’t sufficient. Two essential preconditions must be met before the 2010 criteria can appropriately be brought to bear in diagnosing RA in the clinic.
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