Rheumatoid Arthritis 5.0

From the annual scientific sessions of the American College of Rheumatology in Philadelphia

Rheumatologists have remade rheumatoid arthritis, a pretty big deal for them if only because it’s “the major systemic rheumatic disease that we as a specialty treat,” said Dr. Michael E. Weinblatt, a Harvard rheumatologist, at the end of a 90-minute session on Sunday afternoon that unveiled a new definition of rheumatoid arthritis to the world.

The culmination of a 3-year collaboration between the American College of Rheumatology and the European League Against Rheumatism (EULAR), the new RA definition, the first in more than 20 years, is a consensus agreement from a large panel of experts on which patients with a new inflammatory arthritis have enough risk of progressing to erosive arthrtis that all rheumatologists would immediately start treatment with a disease modifying drug.

“We need to change the way we think about arthritis,” because today “the aim is to prevent development of the disease that satisfied the 1987 ACR  criteria,” said Dr. Alan J. Silman, a rheumatologist at Manchester University, UK. “Satisfying the 1987 criteria is bad news. No one now waits till the disease becomes erosive to start disease modifying therapy.”

the new RA diagnostic criteria/photo by Mitchel Zoler

The  new criteria use four basic categories of signs and symptoms, and a point system in which a score of 6 or more means definite rheumatoid arthritis, with no need for radiographic change. The score table and the steps that created it were reported by Dr. Gillian A. Hawker, a rheumatologist at Women’s College Hospital in Toronto. This is actually the fifth definition of rheumatoid arthritis, a lineage that began just over 50 years ago with the first definition from the American Rheumatism Association.

A new definition that breaks so dramatically from the old is bound to trigger issues that will take months to sort out, such as  insurance coverage, research designs, and a need to apply the new definition carefully to avoid misdiagnoses. But the main message at Sunday’s session on what this means was that “this sets the stage for us to treat patients earlier,” Dr. Weinblatt said. “It will allow more rapid institution of disease-modifying therapy.”

An article with my full coverage of the new RA diagnostic criteria is here.

—Mitchel Zoler, 1 AM Oct 19 in Wynnewood, PA (on Twitter @mitchelzoler)