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Moon, Lee, Kim, Park, Kang, Kwok, Kim, Ju, Kim, Seo, Choi, Choi, Kim, Kim, Yoon, Hong, Lee, Lee, Song, Park, Kim, and Park: Usefulness and Limitation of 2010 ACR/EULAR Classification Criteria in Korean Patients with Early RA
Original Article
Journal of Rheumatic Diseases

Journal of Rheumatic Diseases 2012; 19(6): 326-333.

Published online: 31 December 2012

DOI: https://doi.org/10.4078/jrd.2012.19.6.326

Usefulness and Limitation of 2010 ACR/EULAR Classification Criteria in Korean Patients with Early RA

Su-Jin Moon1, Chang Hoon Lee2, Yun Sung Kim3, Yun-Jung Park1, Kwi Young Kang4, Seung-Ki Kwok1, Hae-Rim Kim5, Ji Hyeon Ju1, Hyun-Sook Kim3, Young Il Seo6, Sang Tae Choi7, Jin-Jung Choi8, Hyun Ah Kim6, Wan-Uk Kim1, Chong-Hyun Yoon1, Yeon-Sik Hong1, Myeung Su Lee2, Sang-Heon Lee5, Jung-Soo Song7, Won Park9, Ho-Youn Kim1, Sung-Hwan Park1

1Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

2Division of Rheumatology, Department of Internal Medicine, Wonkwang University, Iksan, Korea.

3Division of Rheumatology, Department of Internal Medicine, The Chosun University College of Medicine, Gwangju, Korea.

4Division of Rheumatology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.

5Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

6Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.

7Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, Seoul, Korea.

8Division of Rheumatology, Department of Internal Medicine, Kangnam CHA Hospital, CHA University, Seoul, Korea.

9Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.

Corresponding to: Sung-Hwan Park, Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, 222, Banpodae-ro, Banpo-dong, Seocho-gu, Seoul 137-701, Korea. rapark@catholic.ac.kr

Received 7 February 2012       Revised 3 October 2012       Accepted 4 October 2012

Copyright © 2012 by The Korean College of Rheumatology

(free-access):

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The 2010 New American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for rheumatoid arthritis (RA) was raised to identify patients with early RA and replaced the 1987 ACR classification criteria. The aims of this study are to assess the availability of new classification criteria and to evaluate its potential limitation.

Methods

A total of 408 patients with newly diagnosed RA were included from 13 secondary or tertiary hospitals in South Korea. The symptom duration was less than 12 months before the diagnosis of RA. RA was defined as either 1987 ACR classification criteria or new 2010 ACR/EULAR criteria. We compared the full details of both classification criteria.

Results

The mean symptom duration was 5.1 months. The majority (76.2%) of the patients were female. Two hundred and seventy three patients (66.9%) fulfilled both of the 2010 and 1987 classification criteria. Forty-seven (14.7%) of the 320 patients fulfilling the 1987 criteria did not fulfill the new classification criteria. On the other hand, eighty-eight (24.4%) of the 361 patients fulfilling the 2010 ACR/EULAR classification criteria did not fulfill the 1987 ACR criteria. Thirty-six (55.4%) of the 65 patient with seronegative RA failed to meet the 2010 classification criteria. In case of seropositive RA (n=343), 85 additional patients (24.8%) could be diagnosed as RA using new classification criteria.

Conclusion

The new 2010 ACR/EULAR classification criteria enable physicians to diagnose more patients with early RA via the help of serology. However, the sensitivity for the diagnosis of seronegative RA is projected to decrease.

Keywords: Rheumatoid arthritis, Criterion, Diagnosis, Seronegative

Figures and Tables

Figure 1
Prevalence of each items of 1987 ACR classification criteria for RA according to the three groups.
jrd-19-326-g001
Figure 2
Application of 1987 ACR and 2010 ACR/EULAR classification criteria according to the seropositivity of patients. (A) seropositive RA, (B) seronegative RA.
jrd-19-326-g002
Table 1
Demographic and clinical features in Korean patients with newly diagnosed RA
jrd-19-326-i001

ACR: American College of Rheumatology, EULAR: European League Against Rheumatism, RF: rheumatoid factor, ACPA: anti-citrullinated peptide antibody

Table 2
Performance of 2010 ACR/EULAR RA classification criteria for patients with newly diagnosed RA
jrd-19-326-i002

RA: rheumatoid arthritis, RF: rheumatoid factor, ACPA: anti-citrullinated protein antibody. Data are mean±SD or number (%). *p<0.05 among three groups (ANOVA analysis)

Table 3
Prevalence of each items of 1987 ACR classification criteria of our study and other previous reports depending on the satisfaction of the 1987 ACR or 2010 ACR/EULAR criteria, or both criteria
jrd-19-326-i003

Data are represented as number (%). ACR: American College of Rheumatology, EULAR: European League Against Rheumatism, NA: not assessed, RF: rheumatoid factor. *p<0.05 among three groups (ANOVA analysis)

Table 4
Prevalence of each items of 1987 ACR classification criteria for seronegative RA patients
jrd-19-326-i004

Data are represented as number (%). ACR: American College of Rheumatology, RA: rheumatoid arthritis, *p<0.05 among three groups (ANOVA analysis)

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