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A welcome address for the new criteria

After lively presentations at the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) meetings, the new criteria for rheumatoid arthritis (RA) now appear in print accompanied by methodological reports.1 2 The interested reader can thereby follow the entire process from beginning to end. It has been a huge task and the members of the ACR/EULAR joint taskforce deserve our warm congratulations for the result, which is easy to absorb because the reasoning is clear and the manuscripts are well written. Through the combination of a first phase with a data-driven approach followed by a second phase using new consensus methodology, we can be confident that a high-quality product has been delivered.

The main question is why the 1987 ACR criteria for the classification of RA should be revised. The 1987 criteria were derived from patients with RA with mostly longstanding disease and identified features that best discriminated these patients from those with a variety of other rheumatic disorders. In the meantime, the focus of the management of RA has shifted from alleviating the consequences of joint damage to early diagnosis and intervention. The old criteria were increasingly viewed as not helpful in achieving the new goal. The aim of the endeavour of experts leading to new classification criteria was to define the group of patients with a high risk of developing persistent and erosive disease who will likely benefit from the rapid initiation of antirheumatic treatment.

What these criteria actually attempt to do is to separate, at an early stage, patients with undifferentiated arthritis into two groups—one with a poor prognosis and one with a good prognosis. The underlying message could be to treat those with a poor prognosis (RA) aggressively and those with a good prognosis (not RA) symptomatically. Rheumatologists have already become used to …