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Kay, J., and K. S. Upchurch. "ACR/EULAR 2010 rheumatoid arthritis classification criteria." Rheumatology 51, suppl 6 (2012): vi5—vi9. http://dx.doi.org/10.1093/rheumatology/kes279.
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VARACHE, SOPHIE, DIVI CORNEC, JOHANNE MORVAN, et al. "Diagnostic Accuracy of ACR/EULAR 2010 Criteria for Rheumatoid Arthritis in a 2-Year Cohort." Journal of Rheumatology 38, no. 7 (2011): 1250–57. http://dx.doi.org/10.3899/jrheum.101227.
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Objective.To evaluate the diagnostic accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and 1987 ACR criteria for rheumatoid arthritis (RA), and the respective role of the algorithm and scoring of the ACR/EULAR.Methods.In total, 270 patients with recent-onset arthritis of < 1 year duration were included prospectively between 1995 and 1997 and followed for 2 years. RA was defined as the combination, at completion of followup, of RA diagnosed by an office-based rheumatologist and treatment with a disease-modifying antirheumatic drug or glucocorticoid. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the criteria sets in the overall population, in the subgroup meeting the tree condition for ACR/EULAR scoring, and in the overall population classified according the full tree.Results.At baseline, 111 of the 270 patients had better alternative diagnoses and 16 had erosions typical for RA; of the 143 remaining patients, 52 had more than 6 ACR/EULAR 2010 points (indicating definite RA) and 91 had fewer than 6 points. After 2 years, 11/16 patients with erosions and 40/52 with more than 6 points had RA. 100 of the 270 patients met the reference standard for RA. Sensitivity, specificity, PPV, and NPV of the ACR/EULAR (full tree) were 51/100 (51%), 153/170 (90%), 51/68 (75.4%), and 153/202 (75.7%), respectively. Diagnostic accuracies of the ACR/EULAR score and ACR 1987 criteria were not statistically different.Conclusion.Much of the improvement of the ACR/EULAR criteria was ascribable to the use of exclusion criteria in the algorithm.
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Harigai, Masayoshi. "1. 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis." Nihon Naika Gakkai Zasshi 101, no. 10 (2012): 2851–59. http://dx.doi.org/10.2169/naika.101.2851.
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Muravyev, Yu V., and A. S. Misiyuk. "Rheumatoid arthritis classification criteria: debatable problems." Rheumatology Science and Practice 56, no. 6 (2019): 805–7. http://dx.doi.org/10.14412/1995-4484-2018-805-807.
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The paper discusses the issues of imperfect 1987 American College of Rheumatology (ACR) and the 2010 ACR/European League Against Rheumatology (EULAR) rheumatoid arthritis classification criteria and justifies the need for their correction.
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Fautrel, B., B. Combe, N. Rincheval, and M. Dougados. "Level of agreement of the 1987 ACR and 2010 ACR/EULAR rheumatoid arthritis classification criteria: an analysis based on ESPOIR cohort data." Annals of the Rheumatic Diseases 71, no. 3 (2011): 386–89. http://dx.doi.org/10.1136/annrheumdis-2011-200259.
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BackgroundIn 2010, new classification criteria for rheumatoid arthritis (RA) were developed.ObjectiveTo assess agreement between 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria and the potential source of discordance, based on ESPOIR cohort data.Methods813 early arthritis patients were included in ESPOIR between 2002 and 2005. Between-criteria agreement was based on the κ coefficient. Discordance was explored by logistic regression.ResultsData for 811 patients were available, with their main characteristics as follows: women 77%, swollen joint count 7.2, tender joint count 8.4, disease activity score in 28 joints 5.2, rheumatoid factor 46%, anticitrullinated protein antibody (ACPA) 39%, structural damage 22%. At baseline, 579 (71.4%) patients met the 1987 ACR criteria and 641 (79.0%) the 2010 criteria. Agreement at baseline was discordant for 168 patients: 115 satisfied the 2010 criteria and 53 the 1987 criteria. Concordance between the two sets was fair, with a κ coefficient of 0.45 and 0.42 at baseline and year 2, respectively. The main sources of discordance were the number and symmetry of joint involvement, as well as ACPA status.Conclusion2010 ACR/EULAR criteria identified more patients with RA than did 1987 criteria. The 2010 criteria failed to identify RA patients with symmetrical seronegative arthritis and limited joint involvement.
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Cader, Mohammed Z., Andrew Filer, Jonathan Hazlehurst, Paola de Pablo, Christopher D. Buckley, and Karim Raza. "Performance of the 2010 ACR/EULAR criteria for rheumatoid arthritis: comparison with 1987 ACR criteria in a very early synovitis cohort." Annals of the Rheumatic Diseases 70, no. 6 (2011): 949–55. http://dx.doi.org/10.1136/ard.2010.143560.
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ObjectiveEarly 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.MethodsData 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.Results265 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).ConclusionThe 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.
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Belakova, Gabriela, V. Manka, E. Zanova, and P. Racay. "Early Diagnosing and Treatment of Rheumatoid Arthritis, Benefits of Anti-Citrullinated Peptides Examination." Acta Medica Martiniana 17, no. 2 (2017): 28–31. http://dx.doi.org/10.1515/acm-2017-0009.
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AbstractBackground: Anti-citrullinated peptides antibodies (ACPA) are specific for rheumatoid arthritis and have been implicated in disease pathogenesis. ACPA examination is a new component of ACR/EULAR 2010 classification criteria for rheumatoid arthritis. ACPA positivity predicts a more erosive disease course with severe joint damage and extra-articular manifestations. Objectives: To evaluate the benefits of ACPA examination in patients with early undifferentiated arthritis and patients with rheumatoid arthritis. Methods: We examined patients with arthritis and tested them for ACPA positivity. In every individual patient we evaluated if ACPA examination was necessary to establish the diagnosis of rheumatoid arthritis, or to change treatment, or if the diagnosis could have been established without ACPA examination (ACR/EULAR 2010 classification criteria was met without ACPA scoring). Results and Conclusions: We examined 833 patients with arthritis. There were 43 patients, or 62 % of a subgroup of 69 who were ACPA positive whose ACPA examination was not needed - ACR/EULAR criteria was met without ACPA scoring. This number represents 5.1 % of the total number examined. There were 15 patients, or 22 % of the subgroup and 1.8 % of the total whose diagnosis was revised to rheumatoid arthritis due to ACPA positivity - ACR/EULAR criteria was met solely with ACPA scoring. There were 11 patients (16 % and 1.3 %) whose medication was changed due to ACPA positivity. ACPA examination is useful in 3,1 % of all examined patients. When we correlate data on ACPA positive patients, 38 % of the patients profit from ACPA examinations. Considering the relatively low price of ACPA testing, this examination should not be excluded.
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Brinkmann, Gina H., Ellen S. Norli, Tore K. Kvien, et al. "Disease Characteristics and Rheumatoid Arthritis Development in Patients with Early Undifferentiated Arthritis: A 2-year Followup Study." Journal of Rheumatology 44, no. 2 (2017): 154–61. http://dx.doi.org/10.3899/jrheum.160693.
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Objective.To examine the 2-year disease course in patients with undifferentiated arthritis (UA) focusing on fulfillment of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) classification criteria.Methods.Data were provided by the Norwegian Very Early Arthritis Clinic study, which included patients presenting with ≥ 1 swollen joint of ≤ 16 weeks’ duration. UA was defined as patients not fulfilling the 2010 ACR/EULAR RA criteria and who did not have a clinical diagnosis other than RA at baseline. The main outcome was fulfillment of the 2010 RA criteria. Secondary outcomes were disease-modifying antirheumatic drug (DMARD) use, resolution of synovitis without use of DMARD during followup, and final clinical diagnosis.Results.We included 477 patients with UA of whom 47 fulfilled the 2010 ACR/EULAR RA criteria during followup (UA-RA) and 430 did not (UA–non-RA). Of the UA-RA patients, 70% fulfilled the criteria within the first 6 months. UA-RA patients were older, more often positive for rheumatoid factor and anticitrullinated protein antibodies, female, and ever smokers, and they more often presented with polyarticular arthritis, small joint involvement, and a swollen shoulder joint. During followup, 53% of UA-RA patients vs 13% of UA-non-RA patients used DMARD (p < 0.001). Overall, 71% of patients with UA achieved absence of clinical synovitis at final followup without use of DMARD. The most frequent final clinical diagnosis was UA (61%).Conclusion.Only 9.8% of patients with UA fulfilled the 2010 RA criteria during 2-year followup. Small joint involvement and swollen shoulder joint were among the factors associated with RA development. In two-thirds of patients with UA, the arthritis resolved without use of DMARD.
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TEHUPURING, SUKACITA, ARYATI, and LITA DIAH RAHMAWATI. "Profil Klinis dan Laboratorium Pasien Reumatoid Artritis Berdasarkan Kriteria Acr-Eular 2010 Di Poliklinik Reumatologi IRJ RSUD Dr.Soetomo Surabaya Tahun 2018." Hang Tuah Medical Journal 19, no. 2 (2022): 239–56. http://dx.doi.org/10.30649/htmj.v19i2.174.
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Latar Belakang: Kriteria ACR-EULAR 2010 ditetapkan bertujuan untuk mendiagnosis Reumatoid Artritis (RA) lebih awal. Diharapkan hasil penelitian ini dapat memberikan bukti data profil pasien RA yang bisa dipakai secara nasional untuk menggambarkan perkembangan medis terkait RA. Profil yang dipilih adalah profil klinis dan laboratorium untuk merepresentasikan morbiditas, prognosis, dan perjalanan penyakit. Pasien dewasa dipilih untuk merepresentasikan dampak sosial ekonomi dan RSUD Dr. Soetomo dipilih sebagai sumber data untuk dapat merepresentasikan kasus RA di Indonesia Timur.
 Tujuan: Untuk mengetahui profil klinis dan laboratorium pasien RA berdasarkan kriteria ACR-EULAR 20210 di poliklinik Reumatologi IRJ RSUD Dr. Soetomo tahun 2018.
 Metode: Penelitian deskriptif-retrospektif menggunakan data rekam medis pasien RA di RSUD Dr. Soetomo.
 Hasil: 100% pasien dalam penelitian ini adalah wanita. Distribusi usia paling tinggi adalah 45-64 tahun 47,83%, 35-44 tahun 30.43%, 15-24 tahun 13,04%, 25-34 tahun 8,70% dengan median 43 tahun. Sebanyak 82,61% berpendidikan SMA dan 4,35% berpendidikan SMP dan 8,70% berpendidikan lebih rendah. 56,52% pasien berdomisili di luar Surabaya dan 43,44% pasien berdomisili di dalam kota Surabaya. 52,17% pasien terkena gejala RA pada 4–10 sendi keci, 13,04% pasien terkena pada lebih dari 10 sendi (minimal 1 sendi kecil) dan sebesar 17,39% pasien terkena pada 2–10 sendi besar dan 1–3 sendi kecil. 95,65% pasien menderita sakit 6 minggu atau lebih dan hanya 4,35% pasien yang sakitnya kurang dari 6 minggu. 65,22% pasien menunjukkan serologis RF positif. 91,30% pasien dengan anti-MCV positif. 95,65% pasien dengan LED di atas batas normal dengan median 55 mm/jam. 30,34% pasien menunjukkan CRP di atas batas normal, 26,09% pasien dengan CRP dalam batas normal sedangkan 43,48% pasien tidak ada data hasil pemeriksaan CRP. Evaluasi berdasarkan kriteria ACR-EULAR 2010 menunjukkan 43,48% pasien dengan skor 8; 26,09% pasien dengan skor 6; 4,35% pasien dengan skor 7; dan, 13.04% pasien dengan skor 9 dan dengan skor 10.
 Kesimpulan: Pasien Reumatoid Artritis di poliklinik Reumatologi IRJ RSUD Dr. Soetomo Surabaya tahun 2018 memiliki profil demografis lebih banyak berusia di atas 45 tahun, dengan tingkat pendidikan SMA, berasal dari luar kota Surabaya dan semuanya berjenis kelamin wanita; dengan profil klinis memiliki keterlibatan 4–10 sendi dengan lama sakit lebih dari 6 minggu; memiliki profil laboratorium dimana sebagian besar menunjukkan hasil serologis RF dan Anti-MCV yang positif, dengan angka LED di atas normal pada sebagian besar sampel; serta memiliki profil ACR-EULAR 2010 pada skor 8 dengan jumlah sampel terbesar dan pada skor 7 dengan jumlah sampel terkecil.
 Kata kunci: Reumatoid Artritis, ACR-EULAR 2010, RSUD Dr. Soetomo
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Morton, F., J. Nijjar, C. Goodyear, and D. Porter. "AB0210 ACREULAR: AN R PACKAGE FOR THE CALCULATION AND VISUALISATION OF ACR/EULAR RELATED RHEUMATOID ARTHRITIS MEASURES." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1405.1–1406. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2326.
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Background:The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) individually and collaboratively have produced/recommended diagnostic classification, response and functional status criteria for a range of different rheumatic diseases. While there are a number of different resources available for performing these calculations individually, currently there are no tools available that we are aware of to easily calculate these values for whole patient cohorts.Objectives:To develop a new software tool, which will enable both data analysts and also researchers and clinicians without programming skills to calculate ACR/EULAR related measures for a number of different rheumatic diseases.Methods:Criteria that had been developed by ACR and/or EULAR that had been approved for the diagnostic classification, measurement of treatment response and functional status in patients with rheumatoid arthritis were identified. Methods were created using the R programming language to allow the calculation of these criteria, which were incorporated into an R package. Additionally, an R/Shiny web application was developed to enable the calculations to be performed via a web browser using data presented as CSV or Microsoft Excel files.Results:acreular is a freely available, open source R package (downloadable fromhttps://github.com/fragla/acreular) that facilitates the calculation of ACR/EULAR related RA measures for whole patient cohorts. Measures, such as the ACR/EULAR (2010) RA classification criteria, can be determined using precalculated values for each component (small/large joint counts, duration in days, normal/abnormal acute-phase reactants, negative/low/high serology classification) or by providing “raw” data (small/large joint counts, onset/assessment dates, ESR/CRP and CCP/RF laboratory values). Other measures, including EULAR response and ACR20/50/70 response, can also be calculated by providing the required information. The accompanying web application is included as part of the R package but is also externally hosted athttps://fragla.shinyapps.io/shiny-acreular. This enables researchers and clinicians without any programming skills to easily calculate these measures by uploading either a Microsoft Excel or CSV file containing their data. Furthermore, the web application allows the incorporation of additional study covariates, enabling the automatic calculation of multigroup comparative statistics and the visualisation of the data through a number of different plots, both of which can be downloaded.Figure 1.The Data tab following the upload of data. Criteria are calculated by the selecting the appropriate checkbox.Figure 2.A density plot of DAS28 scores grouped by ACR/EULAR 2010 RA classification. Statistical analysis has been performed and shows a significant difference in DAS28 score between the two groups.Conclusion:The acreular R package facilitates the easy calculation of ACR/EULAR RA related disease measures for whole patient cohorts. Calculations can be performed either from within R or by using the accompanying web application, which also enables the graphical visualisation of data and the calculation of comparative statistics. We plan to further develop the package by adding additional RA related criteria and by adding ACR/EULAR related measures for other rheumatic disorders.Disclosure of Interests:Fraser Morton: None declared, Jagtar Nijjar Shareholder of: GlaxoSmithKline plc, Consultant of: Janssen Pharmaceuticals UK, Employee of: GlaxoSmithKline plc, Paid instructor for: Janssen Pharmaceuticals UK, Speakers bureau: Janssen Pharmaceuticals UK, AbbVie, Carl Goodyear: None declared, Duncan Porter: None declared
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Mäkinen, Heidi, Kalevi Kaarela, Heini Huhtala, Pekka J. Hannonen, Markku Korpela, and Tuulikki Sokka. "Do the 2010 ACR/EULAR or ACR 1987 classification criteria predict erosive disease in early arthritis?" Annals of the Rheumatic Diseases 72, no. 5 (2012): 745–47. http://dx.doi.org/10.1136/annrheumdis-2012-201943.
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ZEIDLER, HENNING. "The Need to Better Classify and Diagnose Early and Very Early Rheumatoid Arthritis." Journal of Rheumatology 39, no. 2 (2011): 212–17. http://dx.doi.org/10.3899/jrheum.110967.
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Early rheumatoid arthritis (RA) and very early RA are major targets of research and clinical practice. Remission has become a realistic goal in the management of RA, particularly in early disease. The 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria, the EULAR treatment recommendations for RA, and the EULAR recommendations for the management of early arthritis focus on early disease and translate the knowledge related to early RA into classification and management. Nevertheless, there is a need for further improvement and progress. Results from 6 recent studies are summarized, evaluating the performance of the 2010 ACR/EULAR RA classification criteria. The data show a significant risk of misclassification, and highlight that overdiagnosis and underdiagnosis may become important issues if the criteria recommend synthetic and biological disease-modifying antirheumatic drugs. Therefore, some considerations are presented on how the current problems and limitations could be overcome in clinical practice and future research. A consensus is needed to better define the early phase of RA and differentiate from other early arthritis. The possible effect of misclassification on spontaneous and drug-induced remission of early and very early RA awaits further elucidation. Such research will eventually lead to more reliable diagnostic and classification criteria for new-onset RA.
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van der Heijde, Désirée, Annette H. M. van der Helm-van Mil, Daniel Aletaha, et al. "EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria." Annals of the Rheumatic Diseases 72, no. 4 (2013): 479–81. http://dx.doi.org/10.1136/annrheumdis-2012-202779.
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Martinez Calabuig, P., J. J. Fragío Gil, A. Rueda, et al. "AB1459 IGG4-RELATED DISEASE: 2010-2022 CASE REVISION AND PERFORMANCE OF DIAGNOSTIC CRITERIA." Annals of the Rheumatic Diseases 82, Suppl 1 (2023): 1957. http://dx.doi.org/10.1136/annrheumdis-2023-eular.3260.
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BackgroundIgG4 immunoglobulin-related disease (IgG4-RD) is a rare, systemic immune-mediated fibro-inflammatory process with unclear etiology and pathophysiology. Can affect multiple organs that encompass common pathophysiological, serological and clinical characteristics.ObjectivesTo describe the heterogeneity of the clinical presentation, evolution, and treatment of patients diagnosed with IgG4-RD and compare the performance of the last two IgG4-RD classification and diagnostic criteria.MethodsSingle-center retrospective study in which patients with a possible diagnosis of IgG4-RD from various hospital departments are studied from January 2010 to August 2022. Some exclusion criteria were applied (patients with clinical manifestations attributable to other diseases were excluded) and to those who remained with a suspected diagnosis of IgG4-RD, the Umehara-Okazaki 2011 and ACR/EULAR 2019 criteria were applied.Results182 patients with elevated IgG4 and/or a suspected diagnosis of IgG4-RD were collected. Finally, after exclusion criteria, 22 possible patients with IgG4-RD remained (Table 1). The diagnostic criteria proposed by Umehara and Okazaki in 2011 are applied to these patients, including a total of 13 patients, with a mean age of 60 years, 57% women; 5 being classified with definitive disease, 3 as probable disease and 5 as possible disease. Finally, we applied the ACR/EULAR 2019 classification criteria to those patients too, establishing diagnosis in 7 patients. The mean age was 57 years, 71% were women with a mean follow-up of 5.3 years; 85.71% of the patients had elevated IgG4, with mean levels of 176.3 mg/dL. Retroperitoneal fibrosis and aortitis was the most prevalent presentation in both groups (2011 and 2019 criteria) with 38.5% and 28.6% respectively.ConclusionIgG4-RD is a recently described entity that is very heterogeneous in terms of its clinical, analytical and histopathological presentation. According to our series, clinical heterogeneity is the rule, being the retroperitoneal fibrosis and aortitis the most frequent. There are differences when we use the different criteria. ACR/EULAR 2019 classification criteria are stricter criteria that allows us to classify patients more accurately. In our series 6 patients fulfilled Umehara-Okazaki criteria but not ACR/EULAR due to giving more importance to histopathology, clinical manifestations and the need to reach a minimum score in which, for example, only IgG4 levels are not enough. Therefore, on many occasions, a multidisciplinary approach with experienced teams is necessary.References[1]Wallace ZS, Naden RP, Chari S, et al. The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria for IgG4-Related Disease.Arthritis Rheumatol. 2020 Jan;72(1):7-19.[2]Umehara H, Okazaki K, Masaki Y, et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol. 2012 Feb;22(1):21-30.Table 1.High diagnostic IgG4-RD group, Umehara and Okazaki 2011 and ACR/EULAR 2019 IgG4-RD criteria.High diagnostic suspition of IgG4-RDn=22Umehara-Okazaki criteria 2011n=13ACR/EULAR criteria 2019n=7Age, median (IQR), years62 (34-87)60 (34-82)57 (34-79)Sex, female (%)54,5461,5471,42Follow-up, median (IQR), years5,18 (1-28)4,4 (1-9)5,3 (1-9)Death, n (%)9,097,690IgG4 level, median (IQR), mg/dL152 (32,6- >194)163,71 (56,6 ->194)176,3 (109- >194)Elevated IgG4, n (%)63,6384,6285,71Normal IgG4, n (%)13,637,690No evaluated IgG4, n (%)22,727,6914,29CRP, median (IQR), mg/dL3,33 (0-10,7)3 (0,1 -10,7)6 (0,39 -7,8)ESR, median (IQR), mm/h32,89 (7-120)42 (10 -120)48,4 (16-120)Available biopsy at IgG4 involvement site (%)40,9169,23100Clinical phenotypesPancreatohepatobiliary, n (%)18,1815,3814,28Retroperitoneum and aorta, n (%)40,9138,4628,57Head and neck limited, n (%)4,557,690Mickulicz and systemic, n (%)4,557,6914,28Undefined phenotype, n (%)31,8230,7742,86Initial corticotherapy, n (%)90,9184,6185,71Image 1.Diagostic secuence used with IgG4-RD patients.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Shapoval, I., M. Stanislavchuk, and H. Movchan. "THU0480 EXPERIENCE USING DIFFERENT CRITERIA OF FIBROMYALGIA IN PATIENTS WITH ANKYLOSING SPONDYLITIS: 1990 AMERICAN COLLEGE OF RHEUMATOLOGY CLASSIFICATION CRITERIA VS. NEW." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 477.1–478. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2615.
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Background:Fibromyalgia (FM) is a very frequent condition in patients with diseases associated with pain syndrome, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and other chronic rheumatic diseases. FM, RA and AS has different clinical characteristics, but can share symptoms such as pain, fatigue and sleep disturbance that leads to delay in appropriation correct diagnosis [1]. For today well known many different criteria for FM: 1990 American College of Rheumatology (ACR) classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and new AAPT Diagnostic Criteria for Fibromyalgia. According to the literature, prevalence FM in AS patients can reach from 12.6 to 28.5%, but prevalence estimates should be interpreted with care as no data that the criteria for FM have been validated for use in patients with AS and other chronic inflammatory arthritis [1, 2]. The lack of appropriate information needs further investigation for better identification FM.Objectives:The aim of our study was to compare the presence of FM by 1990 ACR classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and new criteria FM 2019 - AAPT Diagnostic Criteria for Fibromyalgia in AS patients.Methods:One hundred and thirteen AS patients (19 women and 94 men) with mean age (M ± SD) 42.3±10.94 years were enrolled in the study. Diagnosis AS was established according to modified New York criteria. For FM detection were used 1990 ACR classification criteria, modified 2010 ACR diagnostic criteria, 2016 Fibromyalgia Diagnostic Criteria and AAPT Diagnostic Criteria for Fibromyalgia. All patients were asked to complete self-reported disease-related questionnaires for patients with AS.Results:According 1990 ACR criteria, FM met in 26 patients (23%). 38.1% patients were positively screened for FM due to modified 2010 ACR diagnostic criteria, and in 31.9% patients according 2016 Fibromyalgia Diagnostic Criteria, and in 41.6% patients due to AAPT Diagnostic Criteria for Fibromyalgia. All new criteria correlated with 1990 ACR classification criteria with p<0,01: r=0.654, r=0.664, r=0.520, concordantly. Using the ROC analysis, we evaluated the sensitivity and specificity of different FM criteria in patients with AS. Our results showed high diagnostic value of all new criteria, but the most sensitive for detection FM in patients with AS were the modified 2010 ACR diagnostic criteria with sensitivity of 96% and specificity of 79%.Conclusion:Our study results confirmed very high prevalence FM in patients with AS.The most sensitive tool for detection FM in patients with AS were the modified 2010 ACR diagnostic criteria with sensitivity of 96% and specificity of 79%.The similar percentages of FM due to different classification criteria might be a good sign in context of the validity of these criteria for AS patient.References:[1]Zhao, S. S., Duffield, S. J., & Goodson, N. J. (2019). The prevalence and impact of comorbid fibromyalgia in inflammatory arthritis.Best Practice & Research Clinical Rheumatology, 1014-23.[2]Salaffi, F., De Angelis, R., Carotti, M., Gutierrez, M., Sarzi-Puttini, P., & Atzeni, F. (2014). Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity.Rheumatology international,34(8), 1103-1110.Disclosure of Interests: :None declared
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Van Hoovels, Lieve, Julie Jacobs, Bert Vander Cruyssen, Stefanie Van den Bremt, Patrick Verschueren, and Xavier Bossuyt. "Performance characteristics of rheumatoid factor and anti-cyclic citrullinated peptide antibody assays may impact ACR/EULAR classification of rheumatoid arthritis." Annals of the Rheumatic Diseases 77, no. 5 (2018): 667–77. http://dx.doi.org/10.1136/annrheumdis-2017-212365.
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ObjectivesRheumatoid factor (RF) and anti-cyclic citrullinated protein/peptide antibodies (ACPA) are integrated in the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis (RA). The objectives of this study were to evaluate the technical and diagnostic performance of different RF and ACPA assays and to evaluate whether differences in performance impact RA classification.MethodsSamples from 594 consecutive patients who for the first time consulted a rheumatologist (44 of whom were diagnosed with RA) and 26 extra newly diagnosed patients with RA were analysed with six different RF assays (Menarini, Thermo Fisher, Inova, Roche, Abbott, Euroimmun) and seven different ACPA assays (Menarini, Thermo Fisher, Inova, Roche, Abbott, Euro Diagnostica, Euroimmun).ResultsWe found differences in analytical performance between assays. There was poor numerical agreement between the different RF and ACPA assays. For all assays, the likelihood ratio for RA increased with increasing antibody levels. The areas under the curve of receiver operating characteristic analysis of the RF (range 0.676–0.709) and ACPA assays (range 0.672–0.769) only differed between some ACPA assays. Nevertheless, using the cut-off proposed by the manufacturer, there was a large variation in sensitivity and specificity between assays (mainly for RF). Consequently, depending on the assay used, a subgroup of patients (13% for RF, 1% for ACPA and 9% for RF/ACPA) might or might not be classified as RA according to the 2010 ACR/EULAR criteria.ConclusionDue to poor harmonisation of RF and ACPA assays and of test result interpretation, RA classification according to 2010 ACR/EULAR criteria may vary when different assays are used.
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Tam, Cheuk Yin, Tsz Ho Cheng, Lai Shan Tam, and Ho So. "Unveiling Predictive Parameters for Rheumatoid Arthritis Development in Arthralgia Patients: Insights from a Prospective Longitudinal Study." Journal of Clinical Rheumatology and Immunology 24, supp01 (2024): 22–23. http://dx.doi.org/10.1142/s2661341724740213.
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Background: Early diagnosis of rheumatoid arthritis (RA) is crucial for timely intervention and improved outcomes. Although research on the preclinical phase of RA is a prominent topic, there remains an unmet need to effectively stratify patients at risk of developing RA based on basic clinical assessment and laboratory investigations. This prospective longitudinal study aimed to identify risk factors for RA development in individuals experiencing arthralgia. Method: Two hundred consecutive adults with arthralgia were enrolled from new referrals to our rheumatology clinic. Patients with synovitis or a known arthritis diagnosis were excluded. Follow-up assessments were conducted every 6 months, or sooner if symptoms worsened, for a maximum of 2 years. The study endpoint was the development of RA, according to the 2010 ACR/EULAR classification criteria. Baseline demographic characteristics, clinical parameters, serology, and acute phase reactant levels were compared between patients who developed RA and those who did not. In addition, the classification score based on the 2010 ACR/EULAR classification criteria was utilised as a composite weighted score summarising the clinical presentation in the cohort, although the patients were deemed not fulfilling the mandatory criteria of having synovitis at baseline. Results: By May 2024, 104 patients had been followed up for at least one year, with a median duration of 78 weeks (IQR: 58-97). The baseline symptom duration was 51 weeks (IQR: 29 – 97). Among these patients, 23 (22.1%) developed RA after a median follow-up duration of 41 weeks (IQR: 25 – 52). Patients who developed RA had a significantly higher proportion of joint symptoms <1 year, difficulty making a fist, positive rheumatoid factor (RF), anti-CCP antibodies, and elevated ESR and CRP levels at baseline. Multivariate logistic regression identified difficulty making a fist (OR: 4.87, 95% CI: 1.40 – 17.04, p = 0.013) and positive anti-CCP antibodies (OR: 13.04, 95% CI: 3.74 – 45.44, p < 0.001) as independent predictors for RA development. Meanwhile, patients who developed RA had significantly higher baseline scores extrapolating from the 2010 ACR/EULAR classification criteria compared to the non-RA group. Conclusion: Difficulty making a fist and positive anti-CCP antibodies are independent predictors of RA development. Additionally, patients who developed RA exhibited significantly higher baseline scores on the 2010 ACR/EULAR classification criteria. Early recognition of these variables and taking reference from the score of classification criteria may aid in RA risk stratification. Further research is needed to validate these findings and explore additional predictive markers.
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Schmitt, M., A. Ramon, P. Ornetti, and J. F. Maillefert. "THU0441 DIAGNOSTIC ACCURACY OF THE NIJMENGEN SCORE FOR GOUTY ARTHRITIS IN PATIENTS HOSPITALIZED FOR ACUTE MONOARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 457.2–458. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5999.
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Background:The gold-standard for diagnosis of gout is the identification of monosodium urate (MSU) crystal in joint fluid. However, the sensitivity, specificity, and reproducibility of such analysis are not excellent, and joint aspiration is sometimes difficult, or impossible. The Nijmengen score is an easy-to-use rule without joint fluid analysis with excellent validity, in primary as well as in secondary care (1, 2). However, it’s validity as not been evaluated in the particular situation of patients whose acute arthritis necessitates hospitalization.Objectives:The objective of the present study was to assess diagnosis performances of the score in patients hospitalized for acute monoarthritis.Methods:Inclusion: all patients hospitalized for acute monoarthritis in the rheumatology department of the Dijon University Hospital between 2016 and 2019.Assessment: 1- clinical examination by an experimented rheumatologist; 2- joint aspiration and synovial fluid analysis following aspiration; 3- ultrasound (US) examination of the knees, first metatarso-phalangeal joints, and arthritic joint by a trained rheumatologist; 4- dual-energy computed tomography (DECT) of the arthritic joint; 5- Nijmengen score (cutoff scores of ≥ 8 needed for diagnosis of gout, and ≤ 4 to rule out gout) and ACR/EULAR 2015 classification criteria (3) (cut-off score of ≥ 8 needed for diagnosis of gout).Analysis: positive and negative predictive values, and ROC curve analysis of the Nijmengen score, using as gold-standard on one hand the results of the MSU crystal research, on the other hand those of the ACR/EULAR criteria.Results:A total of 39 patients were included (mean age = 69.8 ± 15 years, 74.4 % males, mean BMI = 27.5 ± 4.6 Kg/m2, mean serum uric acid = 354.6 ± 117.5 µmol/l). The affected joints were the knee (n = 31), ankle (n = 3), hip (n = 2), wrist (n = 2), shoulder (n = 1). Joint fluid analysis revealed MSU crystal in 11 patients. The ACR/EULAR was ≥ 8 in 15 patients. The Nijmengen score was ≥ 8 in 11 patients, including 5 with MSU crystal on joint fluid analysis and 9 with an ACR/EULAR score ≥ 8. The Nijmengen score was ≤ 4 in 15 patients, including 14 with no MSU crystal on joint fluid analysis and 14 with an ACR/EULAR score < 8. The positive predictive values of a Nijmengen score ≥ 8 were 45 % (joint fluid analysis as gold standard) and 81.8 % (ACR/EULAR). The negative predictive values of a Nijmengen score ≤ 4 were 93.3 % (joint fluid analysis and ACR/EULAR as gold standard). On ROC curve analyses, the areas under the curve were 0.763 (95% CI = 0.612 – 0.914) using joint fluid analysis as gold standard (figure 1) and 0.908 (95% CI = 0.814 – 1.0) using the ACR/EULAR score as gold standard (figure 2).Fig. 1ROC curve (fluid analysis as gold standard)Fig. 2Roc curve (ACR/EULAR as gold standard)Conclusion:Although having been developed for use in primary-care, the Nijmengen score appears to be useful in patients hospitalized for acute monoarthritis in a rheumatology unit.References:[1]Janssens et al. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med 2010; 170:1120-6.[2]Kienhorst L et al. The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. Rheumatology 2015; 54:609-14.[3]Neogi T et al. 2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative: ACR/EULAR CLASSIFICATION CRITERIA FOR GOUT. Arthritis and Rheumatology. oct 2015;67(10):2557-68.Disclosure of Interests: :marie Schmitt: None declared, André Ramon: None declared, Paul Ornetti: None declared, jean Francis Maillefert Grant/research support from: Abbot, shugai, Roche, pfiser, BMS,, Speakers bureau: Abbot, Shugai, Roche, Pfiser, BMS
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RAJA, RAFI, PETER T. CHAPMAN, JOHN L. O’DONNELL, et al. "Comparison of the 2010 American College of Rheumatology/European League Against Rheumatism and the 1987 American Rheumatism Association Classification Criteria for Rheumatoid Arthritis in an Early Arthritis Cohort in New Zealand." Journal of Rheumatology 39, no. 11 (2012): 2098–103. http://dx.doi.org/10.3899/jrheum.120226.
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Objective.To compare the performance of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria with the 1987 American Rheumatism Association (ARA) criteria for rheumatoid arthritis (RA) in an early arthritis cohort.Methods.The study included 79 patients with early arthritis (symptoms < 12 months) and a minimum of 1 year of followup between January 2004 and August 2010. Case notes were reviewed to determine which criteria were fulfilled at initial, 3-month, 1-year, and 2-year visits. Requirements for disease-modifying antirheumatic drug (DMARD) therapy and presence of joint erosions were compared at 2 years.Results.At the initial visit, twice as many patients fulfilled the 2010 criteria (67%) compared with the 1987 criteria (34%; p < 0.001). Forty-four percent of patients who fulfilled only the 2010 criteria at the initial visit went on to fulfill both 1987 and 2010 criteria at 3 months (p < 0.001). Eight patients did not meet the 1987 RA criteria solely because of short symptom duration. All 17/79 patients who developed joint erosions went on to eventually fulfill both criteria. Of those patients who fulfilled only the 2010 criteria at baseline, 25/27 (93%) ultimately received DMARD therapy compared with 24/26 (92%) of those fulfilling both 1987 and 2010 criteria.Conclusion.The 2010 ACR/EULAR RA criteria allowed earlier RA classification compared to the 1987 ARA criteria, although both criteria were equivalent in predicting joint erosions and subsequent need for DMARD (Australian New Zealand Clinical Trials Registry ANZCTR 12608000292370).
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de Launay, Daphne, Marleen GH van de Sande, Maria JH de Hair, et al. "Selective involvement of ERK and JNK mitogen-activated protein kinases in early rheumatoid arthritis (1987 ACR criteria compared to 2010 ACR/EULAR criteria): a prospective study aimed at identification of diagnostic and prognostic biomarkers as well as therapeutic targets." Annals of the Rheumatic Diseases 71, no. 3 (2011): 415–23. http://dx.doi.org/10.1136/ard.2010.143529.
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ObjectivesTo investigate the expression and activation of mitogen-activated protein kinases in patients with early arthritis who are disease-modifying antirheumatic drug (DMARD) naïve.MethodsA total of 50 patients with early arthritis who were DMARD naïve (disease duration <1 year) were prospectively followed and diagnosed at baseline and after 2 years for undifferentiated arthritis (UA), rheumatoid arthritis (RA) (1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism (EULAR) criteria), or spondyloarthritis (SpA). Synovial biopsies obtained at baseline were examined for expression and phosphorylation of p38, extracellular signal regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) by immunohistochemistry and digital analysis. Synovial tissue mRNA expression was measured by quantitative PCR (qPCR).ResultsERK and JNK activation was enhanced at inclusion in patients meeting RA criteria compared to other diagnoses. JNK activation was enhanced in patients diagnosed as having UA at baseline who eventually fulfilled 1987 ACR RA criteria compared to those who remained UA, and in patients with RA fulfilling 2010 ACR/EULAR criteria at baseline. ERK and JNK activation was enhanced in patients with RA developing progressive joint destruction. JNK activation in UA predicted 1987 ACR RA classification criteria fulfilment (R2=0.59, p=0.02) after follow-up, and disease progression in early arthritis (R2=0.16, p<0.05). Enhanced JNK activation in patients with persistent disease was associated with altered synovial expression of extracellular matrix components and CD44.ConclusionsJNK activation is elevated in RA before 1987 ACR RA classification criteria are met and predicts development of erosive disease in early arthritis, suggesting JNK may represent an attractive target in treating RA early in the disease process.
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Brinkmann, Gina Hetland, Ellen S. Norli, Pernille Bøyesen, et al. "Role of erosions typical of rheumatoid arthritis in the 2010 ACR/EULAR rheumatoid arthritis classification criteria: results from a very early arthritis cohort." Annals of the Rheumatic Diseases 76, no. 11 (2017): 1911–14. http://dx.doi.org/10.1136/annrheumdis-2017-211350.
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ObjectiveTo determine how the European League Against Rheumatism (EULAR) definition of erosive disease (erosion criterion) contributes to the number of patients classified as rheumatoid arthritis (RA) according to the 2010 American College of Rheumatology/EULAR RA classification criteria (2010 RA criteria) in an early arthritis cohort.MethodsPatients from the observational study Norwegian Very Early Arthritis Clinic with joint swelling ≤16 weeks, a clinical diagnosis of RA or undifferentiated arthritis, and radiographs of hands and feet were included. Erosive disease was defined according to the EULAR definition accompanying the 2010 RA criteria. We calculated the additional number of patients being classified as RA based on the erosion criteria at baseline and during follow-up.ResultsOf the 289 included patients, 120 (41.5%) fulfilled the 2010 RA criteria, whereas 15 (5.2%) fulfilled only the erosion criterion at baseline. 118 patients had radiographic follow-up at 2 years, of whom 6.8% fulfilled the 2010 RA criteria and only one patient fulfilled solely the erosion criterion during follow-up.ConclusionFew patients with early arthritis were classified as RA based on solely the erosion criteria, and of those who did almost all did so at baseline.
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Britsemmer, K., J. Ursum, M. Gerritsen, L. van Tuyl, and D. van Schaardenburg. "Validation of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: slight improvement over the 1987 ACR criteria." Annals of the Rheumatic Diseases 70, no. 8 (2011): 1468–70. http://dx.doi.org/10.1136/ard.2010.148619.
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Cornec, Divi, Sophie Varache, Johanne Morvan, et al. "Comparison of ACR 1987 and ACR/EULAR 2010 criteria for predicting a 10-year diagnosis of rheumatoid arthritis." Joint Bone Spine 79, no. 6 (2012): 581–85. http://dx.doi.org/10.1016/j.jbspin.2012.01.015.
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Ghib, L. J., A. Barcic, A. D. Bilous, et al. "THU0456 THE “JOINT CRITERIA” FOR FIBROMYALGIA DIAGNOSIS IN RHEUMATOID ARTHRITIS PATIENTS: RELIABILITY COMPARED TO THE 2010 ACR CLASSIFICATION CRITERIA FOR FIBROMYALGIA." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 465.1–465. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3285.
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Background:A significant proportion of rheumatoid arthritis (RA) patients have concomitant fibromyalgia (FM) (1). Associated FM diagnosis in RA patients can determine worse treatment outcomes compared to patients without FM (1). A difference between tender joint count (TJC) and swollen joint count (SJC) ≥7, also named the ”joint criteria” was proposed as being diagnostic for FM in patients with RA. The ”joint criteria” were validated against the 1990 ACR Classification Criteria for FM and are easy to apply to patients with RA (2). Since then, the 2010 ACR Classification criteria for FM, which include somatic symptoms besides pain sensitivity, were developed and validated.Objectives:We aimed to determine the reliability of the joint criteria for fibromyalgia in RA compared to the ACR 2010 Classification Criteria for FM and to compare RA patients diagnosed with FM (FRA) to those without FM in terms of clinical variables.Methods:We performed a cross-sectional study on RA patients who presented in our department during a 3 months period. Tender joint count (TJC), swollen joint count (SJC), patient global assessment of disease activity (PGA) were determined. DAS28 scores were calculated using CRP. We applied the 2010 ACR Classification Criteria and the joint criteria for FM diagnosis. Kappa agreement coefficient was used to determine the reliability of the joint criteria against the 2010 ACR Classification Criteria for FM in patients with RA. Differences between groups were assessed using Mann-Whitney U test for numerical data or Chi square test for ordinal data.Results:We included 100 consecutive RA patients, 84% female, with a mean age of 57.3(12) years and mean disease duration of 14(9) years. Twenty-four patients (24%) had associated FM according to the ACR 2010 Classification Criteria and 22 (22%) patients satisfied the joint criteria for associated FM. The level of agreement between the joint criteria and the ACR 2010 classification criteria for FM was kappa=0.66, p< 0.001, with a sensitivity of 70% and a specificity of 93%. FRA patients had similar demographic and disease characteristics compared to RA patients. Patients with FRA according to the joint criteria had significantly higher PGA, DAS28, and HAQ scores, but similar CRP values and SJC compared to RA patients (Table 1).Table 1.Demographic and clinical data of FRA and RA patientsVariableFRAn=22RAn=78p-valueAge (years)60 (10.7)59 (12.2)0.093Disease Duration (years)13.3 (13)12.2 (7.5)0.589ACPA seropositivity(%)69550.1SJC2(4)2(4)0.7CRP (g/dl)12.8(14.2)8.1(13.7)0.06DAS28CRP4 (1.7)3.5 (1.2)0.009HAQ1.75 (0.5)1 (0.7)<0.001PGA (mm)70(11)44(23)<0.001Data are expressed as mean (SD) or median (IQR)FRA- Fibromyalgic Rheumatoid Arthritis; RA- Rheumatoid Arthritis;ACPA- Anti- citrullinated Protein Antibodies; CRP- C-reactive Protein; SJC- Swollen Joint Count;DAS28CRP- Disease Activity Score; HAQ- Health Assessment Questionnaire; PGA- Patient Global AssessmentConclusion:The joint criteria are diagnostic for FM in RA patients with moderate reliability compared to the ACR 2010 Classification criteria. When diagnosed with the joint criteria, FRA patients have higher disease activity scores despite having similar clinical and laboratory inflammatory markers compared to RA patients.References:[1]Wolfe F, Michaud K. Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic disadvantage characterize RA patients with fibromyalgia. J Rheumatol. 2004;31(4):695–700.[2]Pollard LC, Kingsley GH, Choy EH, Scott DL. Fibromyalgic rheumatoid arthritis and disease assessment. Rheumatology 2010;49(5):924–8.Disclosure of Interests: :None declared
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Chogle, Arun R. "Rheumatoid arthritis 2010 ACR/EULAR classification criteria: How good are they for us?" Indian Journal of Rheumatology 9, no. 3 (2014): 105–6. http://dx.doi.org/10.1016/j.injr.2014.05.001.
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Хамраев, Х. Х., and К. М. Абдиев. "Cardiovascular Risk in Patients with Rheumatoid Arthritis." Кардиология в Беларуси, no. 3 (November 5, 2021): 407–12. http://dx.doi.org/10.34883/pi.2021.13.3.006.
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Цель. Изучить сердечно-сосудистый риск по шкале mSCORE у пациентов с ревматоидным артритом. Материалы и методы. Были обследованы 140 пациентов с РА в возрасте от 35 до 60 лет. Диагноз ревматоидного артрита был поставлен на основе критериев ACR (1987) и ACR/EULAR (2010). Для раннего выявления и прогнозирования сердечно-сосудистого риска использовалась шкала mSCORE (SCORE/EULAR). Результаты. У пациентов с РА наследственные факторы риска (ФР) для сердечно-сосудистых заболеваний были выявлены у 31,4%, абдоминальное ожирение у 35%, АГ у 63,6%, ГХС у 25,7% игиподинамия у 37,9% пациентов. Курили 10,8% пациентов в исследовании, так как большинство (82%) обследуемых были женщины. При этом АГ наблюдалась в 1,5 раза, ГХС в 2,1 раза чаще у мужчин, чем у женщин. Согласно результатам исследования по шкале mSCORE низкий риск был у 52 (37,1%), средний риск у 64 (45,7%), высокий риск был у 14 (10%), а очень высокий риск у 10 (7,2%) пациентов. Заключение. У пациентов с РА применение шкалы mSCORE дает возможность ранней диагностики сердечно-сосудистого риска и своевременной коррекции факторов риска. Purpose. To study cardiovascular risk on the mSCORE scale in patients with rheumatoid arthritis (RA). Materials and methods. We examined 140 RA patients aged from 35 to 60 years. The diagnosis of rheumatoid arthritis was made on the base of the ACR (1987) and ACR/EULAR (2010) criteria. The mSCORE scale (SCORE/EULAR) was used for early detection and prediction of cardiovascular risk. Results. In patients with RA, hereditary risk factors (RF) for cardiovascular diseases were detected in 31.4%, abdominal obesity - in 35%, arterial hypertension (AH) - in 63.6%, hypercholesterolemia - in 25.7%, and hypodynamia - in 37.9% of patients; 10.8% of patients were smoking, the majority (82%) of the surveyed patients were women. At the same time, AH was observed 1.5 times more often, hypercholesterolemia - 2.1 times more often in men than in women. According to the results of the study on the mSCORE scale, 52 (37.1%) patients had low risk, 64 (45.7%) patients had average risk, high risk was in 14 (10%) patients, and a very high risk was in 10 (7.2%) patients. Conclusion. In RA patients, the use of the mSCORE scale gives the opportunity of early diagnostics of cardiovascular risk and timely correction of risk factors.
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Navalho, Márcio, Catarina Resende, Ana Maria Rodrigues, et al. "Bilateral Evaluation of the Hand and Wrist in Untreated Early Inflammatory Arthritis: A Comparative Study of Ultrasonography and Magnetic Resonance Imaging." Journal of Rheumatology 40, no. 8 (2013): 1282–92. http://dx.doi.org/10.3899/jrheum.120713.
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Objective.To compare Doppler ultrasound (US) and 3.0-Tesla magnetic resonance imaging (3.0-T MRI) findings of synovial inflammation in the tendons and joints in an early polyarthritis cohort (patients who presented < 1 year after arthritis onset) using a bilateral hand and wrist evaluation. Also, to evaluate the diagnostic performance of US and MRI findings for rheumatoid arthritis (RA), their ability to predict RA as a diagnostic outcome, and their capacity to improve the accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria in early arthritis.Methods.Forty-five patients (40 women, 5 men; mean age 45.6 yrs) with untreated recent-onset polyarthritis participated in this prospective study and were examined using an US and MRI approach including both wrists and hands. After a followup of 12 months, patients were classified as having RA if they fulfilled the criteria for RA. The proportion of synovitis identified by US and MRI for each joint and tendon region was compared by chi-square test. The diagnostic performance of US and MRI for RA identification was evaluated using receiver-operating curve (ROC) analysis. Possible associations between synovitis for each joint and tendon region as identified by US or MRI and RA diagnosis at 12 months were tested by logistic regression analysis. The diagnostic performance of the ACR/EULAR RA classification criteria corrected by US and MRI joint and tendon counts was evaluated using ROC analysis.Results.Thirty patients fulfilled the ACR/EULAR criteria [early RA (ERA) patients] and the remaining 15 failed to meet these criteria (non-RA). Carpal joint synovitis and tenosynovitis of the flexor tendons was found in 86.7% and 86.7% of patients with ERA on MRI compared with 63.3% and 50% on US, respectively (p < 0.05). The global MRI and US counts revealed a good diagnostic performance for RA diagnosis of both techniques, although MRI was statistically significantly better [area under the curve (AUC) = 0.959 and AUC = 0.853, respectively; z statistic = 2.210, p < 0.05]. MRI identification of carpal joint synovitis (OR 3.64, 95% CI 1.119–11.841), tenosynovitis of the flexor tendons (OR 5.09, 95% CI 1.620–16.051), and global joint and tendon count (OR 2.77, 95% CI 1.249–6.139) were in the multivariate logistic regression model the most powerful predictors of progression toward RA. In the group of ERA patients with US joint and tendon counts ≤ 10, a statistically significant difference was found between the diagnostic performance for RA of the ACR/EULAR criteria as previously described and the diagnostic performance of the MRI-corrected ACR/EULAR criteria (AUC = 0.898 and AUC = 0.986, respectively; z statistic = 2.181, p < 0.05).Conclusion.3.0-T MRI identified a higher prevalence of synovitis in comparison to US in an early polyarthritis cohort. Both techniques have good diagnostic performance for RA although MRI reveals a significantly higher diagnostic capability. Synovitis of carpal joints and of flexor tendons as identified by MRI were the most powerful predictors of progression toward RA. In patients with US joint and tendon counts ≤ 10, MRI can significantly improve the diagnostic performance of the 2010 ACR/EULAR classification criteria.
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Nordberg, Lena Bugge, Siri Lillegraven, Anna-Birgitte Aga, et al. "Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial." RMD Open 4, no. 2 (2018): e000752. http://dx.doi.org/10.1136/rmdopen-2018-000752.
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ObjectivesRecent studies suggest that implementation of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis (RA) leads to higher inflammatory activity in seronegative compared with seropositive patients at time of diagnosis. Our aim was to compare the disease course in seronegative and seropositive patients classified according to the 2010 criteria.MethodsDMARD-naïve patients with RA fulfilling the 2010 criteria were included in the treat-to-target ARCTIC trial and followed for 24 months. We stratified patients as seropositive (rheumatoid factor (RF)+, anticitrullinated protein antibodies (ACPA)+ or both) or seronegative (RF– and ACPA–) and compared disease activity, radiographic progression, treatment response and remission rates across groups.Results230 patients were included with mean (SD) age 51.4 (13.7) years, and 61% were female. 34 patients (15%) were seronegative. At 24 months, disease activity measures, radiographic progression and remission rates were similar between groups, despite more inflammatory activity in seronegative patients at baseline. Treatment response was slower in seronegative compared with seropositive patients. The groups received similar treatment.ConclusionOur findings suggest that among patients with RA classified according to the 2010 ACR/EULAR criteria, seronegative patients respond well to modern treatment strategies. However, treatment response was somewhat slower in seronegative patients and radiographic progression was similar in seronegative and seropositive patients. Our results indicate that seronegative RA is not a mild form of the disease and requires intensive treat-to-target therapy similar to treatment of seropositive RA.
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Cornec, Divi, Sylvain Mathieu, Athan Baillet, et al. "Valeur discriminante des items des critères ACR/EULAR 2010 : analyse systématique de la littérature." Revue du Rhumatisme 78 (January 2011): S3—S10. http://dx.doi.org/10.1016/s1169-8330(11)70002-3.
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Park, Yong-Beom. "Usefulness and Limitation of 2010 ACR/EULAR Classification Criteria in Patients with Early RA." Journal of Rheumatic Diseases 20, no. 1 (2013): 1. http://dx.doi.org/10.4078/jrd.2013.20.1.1.
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Mjaavatten, Maria D., and Vivian P. Bykerk. "Early rheumatoid arthritis: The performance of the 2010 ACR/EULAR criteria for diagnosing RA." Best Practice & Research Clinical Rheumatology 27, no. 4 (2013): 451–66. http://dx.doi.org/10.1016/j.berh.2013.09.001.
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Diffin, Janet G., Mark Lunt, Tarnya Marshall, Jacqueline R. Chipping, Deborah P. M. Symmons, and Suzanne M. M. Verstappen. "Has the Severity of Rheumatoid Arthritis at Presentation Diminished Over Time?" Journal of Rheumatology 41, no. 8 (2014): 1590–99. http://dx.doi.org/10.3899/jrheum.131136.
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Objective.To examine the pattern of disease severity in patients with rheumatoid arthritis (RA) at presentation to the Norfolk Arthritis Register (NOAR) over 20 years.Methods.NOAR is a primary-care–based cohort of patients with recent-onset inflammatory polyarthritis. At baseline, subjects are assessed and examined by a research nurse. The Health Assessment Questionnaire (HAQ) is administered and the DAS28 (28-joint Disease Activity Score) is calculated. Information is collected on disease-modifying antirheumatic drug exposure. In this study, patients (symptom duration of < 2 years at baseline) were grouped into 4 cohorts (Cohort 1: 1990–1994; Cohort 2: 1995–1999; Cohort 3: 2000–2004; Cohort 4: 2005–2008). The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA were applied retrospectively at baseline. Regression analyses were used to examine whether calendar year of presentation to NOAR was associated with baseline HAQ and DAS28 scores. Potential confounders included age at symptom onset, sex, rheumatoid factor, and anticyclic citrullinated peptide antibody positivity.Results.A total of 1724 patients met the ACR/EULAR 2010 RA criteria at baseline. Unadjusted mean DAS28 scores decreased over time. Calendar year of presentation to NOAR was significantly associated with lower DAS28 scores over time [Y = 4.51 + (–0.56 × year) + (0.44 × year2)]. Although unadjusted median HAQ scores increased over time, calendar year of presentation to NOAR was not significantly associated with HAQ scores [Y = (1.1) + (0.023 × year) + (0.05 × year2)]. Similar results were observed in each subpopulation of patients.Conclusion.While baseline disease activity has lessened slightly over time, there has been no improvement in baseline levels of functional disability.
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Steiner, Guenter, Patrick Verschueren, Lieve Van Hoovels, Paul Studenic, and Xavier Bossuyt. "Classification of rheumatoid arthritis: is it time to revise the criteria?" RMD Open 10, no. 2 (2024): e003851. http://dx.doi.org/10.1136/rmdopen-2023-003851.
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Classification criteria have been developed for rheumatoid arthritis (RA) and other rheumatic diseases in order to gather a homogeneous patient population for clinical studies and facilitate the timely implementation of therapeutic measures. Although classification criteria are not intended to be used for diagnosis, they are frequently used to support the diagnostic process in clinical practice, including clinical decision-making. The 2010 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria for RA are capable of identifying the majority of symptomatic patients with RA already in the earliest stages of the disease who are not yet showing radiographic changes. These patients will also profit from the early implementation of therapy with disease-modifying antirheumatic drugs (DMARDs). However, the risk of misclassification is higher as compared with the former 1987 ACR criteria, which were considerably less sensitive to the recognition of patients with early RA. Of note, the presence of rheumatoid factors (RFs) and anticitrullinated protein antibodies (ACPAs) has been attributed equal weight in the 2010 ACR/EULAR criteria and may contribute up to 50% of the score needed for being classified as RA. However, while ACPAs have been proven to be the most specific serological markers of RA, the specificity of RF is moderate, especially at lower titres. This may lead to the misclassification of RF-positive patients and, consequently, the unjustified implementation of DMARD therapy. Therefore, issues arise on how comprehensive the criteria should be and whether they should be updated and adapted to findings from the past two decades that might increase both their specificity and sensitivity.
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Miladi, Saoussen, Wafa Hamdi, Kaouther Maatallah, et al. "Contribution of Ultrasonography of Hands and Wrists in Early Rheumatoid Arthritis." Current Rheumatology Reviews 17, no. 3 (2021): 342–48. http://dx.doi.org/10.2174/1573397117666210219120400.
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Objectives: Early diagnosis and management of rheumatoid arthritis (RA) have improved the outcome of patients. In the last decade, musculoskeletal Ultrasonography (MSUS) had demonstrated its superiority over clinical examination in detecting synovitis in RA. We conducted this present study in order to assess the added value of MSUS in diagnosing early RA. Methods: A cross-sectional study was conducted, including one hundred patients diagnosed RA based on the physician's opinion and presenting with inflammatory arthralgia or swollen joints for more than 6 weeks and less than 2 years. Patients underwent clinical, laboratory, and radiographic examination. MSUS was performed by a radiologist blinded to clinical findings assessing 22 joints of hands. A US ACR/EULAR 2010 score was calculated by replacing the swollen joints of hands with those expressing synovitis in Greyscale US. Agreement between clinical and US ACR/EULAR score was assessed. Results: Among the 2200 joints scanned by the US, synovitis was detected in 81% of patients, an intra-articular effusion in 36% patients, and PD signals in 51% of patients. Flexor tenosynovitis was present in 55% of patients and extensor tenosynovitis in 59% of patients. Synovitis and PD signals were more often detected in wrists. PD mode was found to be correlated with CRP results (r=0,302, p=0,023). The MSUS assessment has demonstrated synovitis on 71% (N=22) patients who were free of swollen joints on clinical examination. Through 13 patients expressing monoarthritis at clinical examination, 69% (N=9) patients were reclassified with oligo or polyarthritis. By adding US data, a further 13 patients accomplished the ACR/EULAR score. A good level of agreement was found between clinical and US ACR/EULAR criteria (k=0,684, p=0,001). Conclusions: MSUS is an inexpensive and accessible examination tool, which should be considered in patients in the onset of an inflammatory rheumatic disease in order to benefit of the window of opportunity and reach remission.
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Isnardi, Carolina A., Margarita Landi, Natali Laufer, et al. "Respuesta immune humoral asociada a las vacunas contra SARS-CoV-2 en pacientes con artritis reumatoidea: datos del registro SAR-CoVAC." Revista Argentina de Reumatología 32, no. 4 (2021): 7–16. http://dx.doi.org/10.47196/rar.v32i4.508.
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Introducción: la artritis reumatoidea (AR) y los tratamientos indicados para su manejo pueden afectar la respuesta a la vacuna para SARS-CoV-2. Sin embargo, aún no se cuenta con datos locales.
 Objetivos: evaluar la respuesta humoral de la vacuna para SARS-CoV-2 y su seguridad en esta población.
 Materiales y métodos: estudio observacional. Se incluyeron pacientes ≥18 años, con AR ACR/EULAR 2010 que recibieron la vacunación para SARS-CoV-2.
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Stomp, Wouter, Annemarie Krabben, Désirée van der Heijde, et al. "Are Rheumatoid Arthritis Patients Discernible from Other Early Arthritis Patients Using 1.5T Extremity Magnetic Resonance Imaging? A Large Cross-sectional Study." Journal of Rheumatology 41, no. 8 (2014): 1630–37. http://dx.doi.org/10.3899/jrheum.131169.
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Objective.Magnetic resonance imaging (MRI) is increasingly used in rheumatoid arthritis (RA) research. A European League Against Rheumatism (EULAR) task force recently suggested that MRI can improve the certainty of RA diagnosis. Because this recommendation may reflect a tendency to use MRI in daily practice, thorough studies on the value of MRI are required. Thus far no large studies have evaluated the accuracy of MRI to differentiate early RA from other patients with early arthritis. We performed a large cross-sectional study to determine whether patients who are clinically classified with RA differ in MRI features compared to patients with other diagnoses.Methods.In our study, 179 patients presenting with early arthritis (median symptom duration 15.4 weeks) underwent 1.5T extremity MRI of unilateral wrist, metacarpophalangeal, and metatarsophalangeal joints according to our arthritis protocol, the foot without contrast. Images were scored according to OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) by 2 independent readers. Tenosynovitis was also assessed. The main outcome was fulfilling the 1987 American College of Rheumatology (ACR) criteria for RA. Test characteristics and areas under the receiver-operator-characteristic curves (AUC) were evaluated. In subanalyses, the 2010 ACR/EULAR criteria were used as outcome, and analyses were stratified for anticitrullinated protein antibodies (ACPA).Results.The ACR 1987 criteria were fulfilled in 43 patients (24.0%). Patients with RA had higher scores for synovitis, tenosynovitis, and bone marrow edema (BME) than patients without RA (p < 0.05). ACPA-positive patients had more BME (median scores 6.5 vs. 4.25, p = 0.016) than ACPA-negative patients. For all MRI features, the predictive value for the presence of RA was low (< 50%). For all MRI features the AUC were < 0.70. Patients who fulfilled ACR/EULAR 2010 criteria but not ACR87 criteria for RA had less synovitis than patients who were positive for RA according to both sets of criteria (p = 0.029).Conclusion.Although patients with RA had higher scores of MRI inflammation and ACPA-positive patients had more BME, the severity of MRI inflammation assessed according to RAMRIS does not accurately differentiate patients with RA from other early arthritis patients.
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Shidara, Kumi, Ayako Nakajima, Eisuke Inoue, et al. "Continual Maintenance of Remission Defined by the ACR/EULAR Criteria in Daily Practice Leads to Better Functional Outcomes in Patients with Rheumatoid Arthritis." Journal of Rheumatology 44, no. 2 (2016): 147–53. http://dx.doi.org/10.3899/jrheum.160395.
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Objective.To evaluate longterm functional outcomes in rheumatoid arthritis (RA) based on the number of times that the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) or the 28-joint Disease Activity Score (DAS28) remission criteria were fulfilled.Methods.Patients with RA who participated in all 6 data collections in an observational cohort from 2008 to 2010 and who fulfilled the DAS28 remission criteria at baseline were studied. Patients were classified by the number of times they fulfilled the ACR/EULAR [Boolean trial, Boolean practice, Simplified Disease Activity Index (SDAI), or Clinical Disease Activity Index (CDAI)] or DAS28 remission criteria at each collection. The OR for the Japanese version of the Health Assessment Questionnaire (J-HAQ) progression, based on the number of times each set of remission criteria was fulfilled, were calculated by logistic regression.Results.A total of 915 patients were studied. The OR (95% CI) for J-HAQ progression were 0.54 (0.33–0.87), 0.55 (0.33–0.92), 0.48 (0.28–0.82), 0.29 (0.16–0.51), 0.24 (0.13–0.47), and 0.07 (0.03–0.15) for those fulfilling the Boolean trial remission from 1 to 6 times. This tendency was also observed for the other 4 criteria. The OR (95% CI) for J-HAQ progression in patients who achieved remission at all 6 data collections were 0.07 (0.03–0.14) for the Boolean practice, 0.10 (0.05–0.20) for the SDAI, and 0.07 (0.04–0.15) for the CDAI, whereas 0.15 (0.08–0.29) for the DAS28.Conclusion.Continual fulfillment of any remission criteria was strongly effective in preventing patients from progression of functional disability; however, the ACR/EULAR criteria appear to be preferable.
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Chandrashekara S, Renuka Panchagnula, Anupama KR, et al. "Differential acute phase response due to infection in AIRDs: A cross-sectional multi-centre study based on RA and SLE." Indian Journal of Inflammation Research 6, no. 1 (2022): 01–09. http://dx.doi.org/10.15305/ijir.v6i1.71.
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Aim: To explore the differences in acute phase responses between infection and disease flare and between viral and bacterial infections. Methods: The retro-prospective, cross-sectional, multi-center study considered subjects who had undergone treatment for infection or disease flare between 2019 to 2021. The patients fulfilling the ACR/EULAR 2010 criteria and 2019 EULAR/ACR criteria for RA and SLE respectively, were recruited from three centers. Patients who did not have autoimmune rheumatic disease or other immune-mediated diseases were considered as controls. The participants were classified into subgroups namely ‘overall’, ‘without autoimmune rheumatic disease’, ‘SLE’ and ‘RA’. The infectious and non-infectious groups, and the bacterial and viral disease groups were compared to evaluate the differences in the parameters namely age, gender, total leucocyte count (TLC), neutrophil count(N), lymphocytes count (L) NLR, CRP and procalcitonin. Student t-test was used for the evaluation of continuous data and chi-square test for categorical data. ROC curves were plotted. The cutoff points of variable at 80% and 90% sensitivity and specificity were estimated for each subgroup to differentiate infection and no-infection.
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Nordberg, Lena Bugge, Siri Lillegraven, Elisabeth Lie, et al. "Patients with seronegative RA have more inflammatory activity compared with patients with seropositive RA in an inception cohort of DMARD-naïve patients classified according to the 2010 ACR/EULAR criteria." Annals of the Rheumatic Diseases 76, no. 2 (2016): 341–45. http://dx.doi.org/10.1136/annrheumdis-2015-208873.
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ObjectivesTo compare the presentation of seropositive and seronegative early rheumatoid arthritis (RA) in disease-modifying antirheumatic drug (DMARD)-naïve patients classified according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria.MethodsAll patients had symptom duration from first swollen joint <2 years and were DMARD naïve with an indication for DMARD treatment. Patients were stratified as seropositive (positive rheumatoid factor (RF)+ and/or anticitrullinated peptide antibody (ACPA)+) or seronegative (RF− and ACPA−), and disease characteristics were compared between groups.ResultsA total of 234 patients were included, and 36 (15.4%) were seronegative. Ultrasonography (US) scores for joints (median 55 vs 25, p<0.001) and tendons (median 3 vs 0, p<0.001), number of swollen joints (median 17 vs 8, p<0.001), disease activity score (DAS; mean 3.9 vs 3.4, p=0.03) and physician global assessment (mean 49.1 vs 38.9, p=0.006) were significantly higher in seronegative patients compared with seropositive. Total van der Heijde-modified Sharp score, Richie Articular Index and patient-reported outcome measures were similar between groups.ConclusionsSeronegative patients had higher levels of inflammation, assessed both clinically and by US, than seropositive patients. These differences may reflect the high number of involved joints required for seronegative patients to fulfil the 2010 ACR/EULAR classification criteria for RA.Trial registration numberNCT01205854; Pre-results.
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Krabben, A., A. Abhishek, K. Britsemmer, et al. "OP0134 Risk stratification in patients with undifferentiated arthritis according to the 2010 ACR/EULAR criteria." Annals of the Rheumatic Diseases 71, Suppl 3 (2013): 98.3–99. http://dx.doi.org/10.1136/annrheumdis-2012-eular.1817.
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Kennish, Lauren, Monalyn Labitigan, Sam Budoff, et al. "Utility of the new rheumatoid arthritis 2010 ACR/EULAR classification criteria in routine clinical care." BMJ Open 2, no. 5 (2012): e001117. http://dx.doi.org/10.1136/bmjopen-2012-001117.
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Radner, Helga, Tuhina Neogi, Josef S. Smolen, and Daniel Aletaha. "Performance of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: a systematic literature review." Annals of the Rheumatic Diseases 73, no. 1 (2013): 114–23. http://dx.doi.org/10.1136/annrheumdis-2013-203284.
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Triolo, Pierfranco, Roberto Rossi, Federica Rosso, Davide Blonna, Filippo Castoldi, and Davide Edoardo Bonasia. "Arthroscopic synovectomy of the knee in rheumatoid arthritis defined by the 2010 ACR/EULAR criteria." Knee 23, no. 5 (2016): 862–66. http://dx.doi.org/10.1016/j.knee.2016.05.010.
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Moon, Su-Jin, Chang Hoon Lee, Yun Sung Kim, et al. "Usefulness and Limitation of 2010 ACR/EULAR Classification Criteria in Korean Patients with Early RA." Journal of Rheumatic Diseases 19, no. 6 (2012): 326. http://dx.doi.org/10.4078/jrd.2012.19.6.326.
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Jung, Se Jin, Sang-Won Lee, You Jung Ha, et al. "Patients with early arthritis who fulfil the 1987 ACR classification criteria for rheumatoid arthritis but not the 2010 ACR/EULAR criteria." Annals of the Rheumatic Diseases 71, no. 6 (2012): 1097–98. http://dx.doi.org/10.1136/annrheumdis-2011-200785.
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Berglin, E., and SR Dahlqvist. "Comparison of the 1987 ACR and 2010 ACR/EULAR classification criteria for rheumatoid arthritis in clinical practice: a prospective cohort study." Scandinavian Journal of Rheumatology 42, no. 5 (2013): 362–68. http://dx.doi.org/10.3109/03009742.2013.776103.
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Rahal, Fadia, Amina Abdessemed, Radia Chetouane, et al. "Early rheumatoid arthritis diagnosis." Batna Journal of Medical Sciences (BJMS) 1, no. 1 (2014): 12–17. http://dx.doi.org/10.48087/bjmstf.2014.1105.
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Rheumatoid arthritis is the most frequent chronic inflammatory rheumatism. Its management, especially in the case of early inflammatory rheumatism should be immediate, if possible, during the first six months of the evolution of the disease and should be adapted to the potential evolution of rheumatism because it is a therapeutic emergency. Management was drastically improved by a better knowledge of pathophysiology (role of anti-CCP antibodies established), a new diagnostic approach (new 2010 ACR/EULAR criteria and new international recommendations), and new prognostic and therapeutic approaches (biologics).
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Muravyev, Yu V. "EXTRA-ARTICULAR MANIFESTATIONS OF RHEUMATOID ARTHRITIS." Rheumatology Science and Practice 56, no. 3 (2018): 356–62. http://dx.doi.org/10.14412/1995-4484-2018-356-362.
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Rheumatoid arthritis (RA) is an immune inflammatory (autoimmune) rheumatic disease of unknown etiology, which is characterized by chronic erosive arthritis and systemic damage to the viscera, and leads to early disability and reduced survival in patients. For its diagnosis, it is currently recommended to use the 2010 ACR/EULAR classification criteria for RA, which should be applied in clinical trials to identify at least one swollen joint, i.e. the presence of arthritis; therefore, the problem of extra-articular manifestations of RA is apparent to stay in the background.
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Karateev, Dmitriy Evgen'evich, Yu A. Olyunin, E. L. Luchikhina, Dmitry Evgenyevich Karateyev, Yu A. Olyunin, and E. L. Luchikhina. "New ACR/EULAR 2010 classification criteria for rheumatoid arthritis: a step forward in its early diagnosis." Rheumatology Science and Practice, no. 1 (February 15, 2011): 10. http://dx.doi.org/10.14412/1995-4484-2011-861.
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Sakellariou, G., C. A. Scirè, F. De Nard, R. Caporali, and C. Montecucco. "THU0153 Does Ultrasonography Improve the Performance of the 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis?" Annals of the Rheumatic Diseases 72, Suppl 3 (2013): A214.3—A215. http://dx.doi.org/10.1136/annrheumdis-2013-eular.681.
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