2010 ACR/EULAR 类风湿关节炎分类标准的应用：针对非常早期的滑膜炎患者与1987年ACR标准的比较

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Ann Rheum Dis doi:10.1136/ard.2010.143560 Clinical and epidemiological research Extended report Performance of the 2010 ACR/EULAR criteria for rheumatoid arthritis: comparison with 1987 ACR criteria in a very early synovitis cohort 1.       Mohammed Z Cader1, 2.       Andrew Filer1,2, 3.       Jonathan Hazlehurst1, 4.       Paola de Pablo1,2, 5.       Christopher D Buckley1,2, 6.       Raza Karim1,2 + Author Affiliations 1.       1Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK 2.       2Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK 1.       Correspondence to Dr Karim Raza, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, Birmingham B15 2TT, UK; k.raza@bham.ac.uk Accepted 2 January 2011 Published Online First 1 February 2011 Abstract Objective Early identification of patients with rheumatoid arthritis (RA) is essential to allow the prompt institution of therapy. The 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, which replace the 1987 classification criteria, have been developed to facilitate such identification in patients with newly presenting inflammatory arthritis. This study therefore assesses the performance of these new criteria in patients with early synovitis. Methods Data were analysed from patients with synovitis seen within 3 months of the onset of inflammatory arthritis. Patients were followed for 18 months to determine outcomes, and data on the cumulative fulfilment of 2010 and 1987 criteria and therapy were recorded. Results 265 patients were included in the study. 60 had alternative diagnoses at baseline. Of the remaining 205 patients, 20% fulfilled both 1987 and 2010 criteria, 3% fulfilled only 1987 criteria and 22% fulfilled only 2010 criteria at baseline. The 2010 criteria, when applied at baseline, detected more patients who eventually required disease-modifying antirheumatic drugs (DMARD) (65 (62%) vs 40 (38%); p<0.001), especially methotrexate (50 (68%) vs 31 (42%); p<0.01), within the first 18 months. However, more patients whose disease eventually resolved without ever requiring DMARD were classified at baseline as RA according to the 2010 criteria than with the 1987 criteria (16 (8%) vs 5 (2%); p=0.01). Conclusion The 2010 ACR/EULAR criteria allow more rapid identification of patients requiring methotrexate compared with the 1987 ACR criteria when applied at baseline. However, overdiagnosis is an important issue to consider if these criteria are to be used in very early disease.

2010 ACR/EULAR 类风湿关节炎分类标准的应用：针对非常早期的滑膜炎患者与1987年ACR标准的比较   Mohammed Z Cader, Andrew Filer, et al,Ann Rheum Dis doi:10.1136/ard.2010.143560 目的 类风湿关节炎(RA)的早期诊断是获得及时治疗的关键。为识别新近出现的炎症性关节炎患者，已经制定2010年美国风湿病学协会(ACR)/欧洲风湿症联盟(EULAR)的分类标准，以取代1987年分类标准。由此，本研究目的是评估这些新标准对早期滑膜炎患者的应用价值。 方法 对炎症性关节炎起病3个月内的滑膜炎患者的数据进行分析。患者随访18个月以确定结果，2010年和1987年标准中涉及的数据和治疗都被记录在案。 结果 共265例患者纳入研究范围。60例患者在入组时诊断为其他疾病。其他205例患者中，20%同时符合1987年和2010年的标准, 3%只符合1987年标准，22%只符合2010年标准。与1987年标准相比，基线时应用2010年标准,能发现较多在18个月内最终需要改变病情抗风湿病药物(DMARD)治疗的患者 (65(62%) vs. 40 (38%),p < 0.001),尤其是甲氨蝶呤(50(68%)vs 31(42%),p < 0.01)。然而, 根据新标准诊断的RA也有较多的患者从未应用DMARD而最终缓解（16(8%) vs 5(2%);p = 0.01)。 结论 基线水平时应用2010年ACR /EULAR标准，比1987年ACR标准能更快识别需要应用甲氨喋呤治疗的患者。但是，如果这些标准使用在非常早期的疾病阶段，过度诊断的问题要提请重视。