Proposals to advance the classification and diagnosis of early and very early rheumatoid arthritis in clinical practice and to overcome the problems and limitations of the 2010 ACR/EULAR RA classification criteria.
| Setting | Proposals |
|---|---|
| Clinical practice | The rheumatologist as the expert strikes a balance between possible or probable RA, depending on the level of confidence |
| Replacement of rheumatoid nodules with ACPA as a criterion in the 1987 ACR classification criteria | |
| The rheumatologist uses a diagnostic certainty scale at baseline (0 to 100 visual analog scale) | |
| Instead of RA, use of “undifferentiated arthritis” (UA) as the diagnostic term until the accurate diagnosis after followup | |
| Use of the prediction rule developed by van der Helm-van Mil, et al27 to estimate the chance of progression to RA in individual patients presenting with UA | |
| Use of imaging techniques (sonography, MRI) to identify erosions earlier | |
| Future research | Discriminative value of HLA-B27 and diagnostic programs for reactive arthritis |
| Definition of exclusion criteria, e.g., not fulfilling classification criteria for PsA and for peripheral SpA | |
| Testing with the “classification tree” method | |
| Testing likelihood ratios for diagnostic decision-making based on the Bayesian approach | |
| Automated, multiplex biomarker assay testing for autoantibodies, cytokines, and bone-turnover products |
ACR: American College of Rheumatology; EULAR: European League Against Rheumatism; RA: rheumatoid arthritis; ACPA: anticitrullinated protein antibodies; MRI: magnetic resonance imaging; PsA: psoriatic arthritis; SpA: spondyloarthritis.