Rheumatoid arthritis classification criteria - It's finally time to move on!

The diagnosis of rheumatoid arthritis (RA) is often challenging, due to a wide spectrum of presentations, progressive changes in disease course over time, and, perhaps, most importantly, lack of a clinical or laboratory gold standard to define the presence or absence of disease. Several attempts at the creation of RA classification criteria have been undertaken; however, each time, there have been significant limitations in applying these criteria to the clinical setting. Several components of the 1987 RA criteria require the presence of established joint damage; thus, they were limited in their ability to identify patients with early disease, potentially delaying initiation of early aggressive therapy until irreversible damage had occurred. With the recognition that early, aggressive therapy has the potential to decrease RA-associated morbidity and significantly alter disease course, there is clearly a need for criteria that also will facilitate early diagnosis and encourage initiation of therapy through disease modifying drugs (DMARDs). This mission recently has been taken on by a combined task force composed of membership from both the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), the outcomes of which are discussed below.