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ID PMID Title PublicationDate abstract
21175732 Being an outpatient with rheumatoid arthritis--a focus group study on patients' self-effic 2011 Jun BACKGROUND: A Danish study compared three different outpatient settings for persons with rheumatoid arthritis (RA). All participants completed a short course before random allocation to one of three groups. A third of the patients continued with planned medical consultations. A third was allocated to a shared care setting with no planned consultations. The final third was allocated for planned nursing consultations every 3 months. Little knowledge exists of patients' experiences at different outpatient settings. AIMS: (1) To explore the patients' experiences of participation in the course and one of the three different outpatient settings and (2) to explore whether some of these experiences can explain possible changes in self-efficacy beliefs. METHOD: In total six focus group interviews were carried out with 33 participants from the three settings. The interviews and the analysis were inspired by phenomenological philosophy. RESULTS: On the short course the participants felt understood, gained new insights and some changed behaviours after attendance. Important themes in experiences from the three outpatient settings were: (1) continuity and relationships with health professionals, (2) a need for others to take control, and (3) contact with health professionals. SPECIFIC FINDINGS: The nursing consultations were experienced as less factual and less authoritarian than the medical consultations. The participants in the shared care setting had a lack of confidence in the GP's competence to manage their RA. However, they felt responsible for taking action in case of a flare up. The study provided opportunities to enhance the participants' self-efficacy beliefs. CONCLUSION: When planning follow-up care, the focus needs to be on continuity, the interpersonal relationship and easy access to health professionals with thorough knowledge of RA. A short course and consultations with nurses and hospital doctors can enhance patients' self-efficacy and thereby strengthen their confidence to assess and manage their own disease.
19822044 Differences and similarities between ankylosing spondylitis and rheumatoid arthritis: epid 2009 Jul Ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are among the most common rheumatic diseases. The epidemiology of these diseases highlights both similarities and differences. Prevalence rates of approximately 0.2-1% have been reported for the diseases, but the rate for AS is increasing while RA is declining. Geographical variations exist in the incidence and prevalence of the diseases, although the majority of studies have been conducted in northern Europe and North America. AS is a predominantly a male disorder, whereas more females are affected by RA. Both diseases result in increased disability, reduced work productivity, and increased mortality rates. These similarities and differences may give us important clues as to the aetiology of both diseases.
20299352 Mr Outside and Mr Inside: classic and alternative views on the pathogenesis of rheumatoid 2010 May Different strategies can be applied to overcome an obstacle: one may either overcome it from the 'outside' or break it from the 'inside'. Similar strategies have been successfully used by two American football players in the 1940s, known as 'Mr Outside' and 'Mr Inside'. In this article, the authors propose similar concepts for initiating joint inflammation. Arthritis may start 'outside' as a primary inflammation of the synovial membrane (synovitis), which later spreads over to adjacent structures resulting in penetration into the bone marrow (outside-in concept). Alternatively, arthritis may start 'inside', in the bone marrow space, and later encroaches upon the synovium (inside-out concept). The authors discuss these two fundamentally different viewpoints on the pathogenesis of arthritis, each one of which bears attractive explanations for the mystery of the pathogenesis of arthritis.
20471892 Assessment of liver fibrosis by transient elastography in rheumatoid arthritis patients tr 2010 Dec OBJECTIVE: This study was designed to assess the degree of liver fibrosis with transient elastography and noninvasive biochemical methods in rheumatoid arthritis patients treated with methotrexate. METHODS: We reviewed the medical records of rheumatoid arthritis patients who were administered methotrexate for more than 3 years. Transient elastography was performed and serological markers of liver fibrosis were evaluated by prospectively and was compared with the result of healthy control group. A correlation of the cumulative dose of methotrexate with the elastography value (kPa) or the level of serological markers was assessed. Two subgroups of patients were compared; patients who received a cumulative dose of methotrexate of less than 4000 mg (group 1) and more than 4000 mg (group 2). A total of 177 consecutive rheumatoid arthritis patients were evaluated. RESULTS: The mean cumulative dose of methotrexate was 3988 ± 1566 mg with doses ranging from 652.5 to 10,415 mg. The mean elastography value of all patients was 4.01 ± 0.77 kPa. The kilopascal values and levels of biochemical markers did not correlate with the cumulative dose of methotrexate, but did correlate with the AST to ALT ratio, AST to platelet ratio index, haptoglobin level. Mean kilopascal values were not statistically different for group 1 and group 2 patients. For rheumatoid arthritis patients treated with a high cumulative dose of methotrexate, significant liver fibrosis is rare and is not accurately detected in patients with liver enzyme abnormalities. CONCLUSION: Taking into account the risk and benefit of a liver biopsy, transient elastography can be recommended as an additional diagnostic option.
21122262 Comparison of the Recent-Onset Arthritis Disability questionnaire with the Health Assessme 2010 Nov BACKGROUND: Physical disability in patients with rheumatoid arthritis (RA) is often assessed by questionnaires. We compared the Recent-Onset Arthritis Disability (ROAD) questionnaire with the Health Assessment Questionnaire (HAQ) disability index (DI) in a cohort of RA patients. The aim of this study was to obtain information on several aspects of construct validity of these measures. METHODS: A cross-sectional multicentre study was carried out among patients with RA who were attending hospital outpatient clinics. The patient group included 196 patients partially or not responding to disease modifying anti-rheumatic drugs. For the evaluation of the psychometric properties of the ROAD in comparison with HAQ-DI this population has been compared to another cohort of 247 outpatients with RA who were participating in a long-term observational study. All patients completed the ROAD and HAQ-DI. Additional comparator composite indices of disease activity were analysed. The ROAD structural validity was first assessed using exploratory factor analysis. Concurrent validity was analysed by Spearman's correlations and cross-tabulations. Discriminant validity to distinguish patients with active and non-active disease was assessed with receiver operating characteristic (ROC) curve analysis. For agreement analysis Bland and Altman plots were calculated. RESULTS: Factor analysis yielded a two-factor ROAD score that accounted for 68.74% of the explained variance in the questionnaire. The first factor, namely upper extremity function/activity daily living and work (ROAD-upper) accounted for 55.6% of the explained variance. The second factor, namely lower extremity function (ROAD-lower) accounted for 13.1% of the explained variance. Significant correlations were found between the scores of the ROAD and the other clinical variables with a high ability to measure pain and disease activity, supporting the concept of convergent construct validity. The discriminatory power of both questionnaires to assess inactive and active RA patients was good, without significant difference. CONCLUSIONS: ROAD is a good alternative to the HAQ-DI for the assessment of physical disability in RA. Use of the ROAD makes it easier and less costly to collect data and reduces the burden on RA patients and should be applied in both clinical trials and routine clinical care settings.
20810395 MRI in early rheumatoid arthritis: synovitis and bone marrow oedema are independent predic 2011 Mar OBJECTIVES: To determine whether MRI and conventional (clinical and laboratory) measures of inflammation can predict 3-year radiographic changes measured by the van der Heijde Sharp score in patients with early rheumatoid arthritis (RA). METHODS: 55 patients with RA with disease duration <1 year participated in this 3-year follow-up study. Patients were evaluated at baseline, 3, 6, 12 and 36 months by swollen and tender joint count, disease activity score based on 28-joint count, erythrocyte sedimentation rate (ESR), C reactive protein, MRI measures of synovitis, bone marrow oedema and tenosynovitis of the dominant wrist, as well as conventional x-rays of the hands and wrists. RESULTS: All measures of inflammation decreased during the follow-up period. ESR, MRI synovitis and MRI bone marrow oedema were independent predictors of 3-year radiographic progression adjusted for age, sex and anti-citrullinated protein antibodies. The 1-year cumulative measures of MRI synovitis and bone marrow oedema provided an improved explanation of variation (adjusted R(2)) in radiographic change compared with the baseline MRI values (adjusted R(2)=0.32 and 0.20 vs 0.11 and 0.04, respectively). CONCLUSIONS: Both baseline and 1-year cumulative measures of MRI synovitis and bone marrow oedema independently predicted 3-year radiographic progression. These results confirm that MRI synovitis and MRI bone marrow oedema precede radiographic progression in patients with early RA.
19389716 Follow-up standards and treatment targets in rheumatoid arthritis: results of a questionna 2010 Mar BACKGROUND: Therapeutic approaches to rheumatoid arthritis (RA) have undergone significant changes. The importance of tight control and early treatment, rapidly altered if goals are not achieved, is supported by evidence. However, it is unknown to what extent these insights are accepted by practitioners in clinical practice. OBJECTIVE: To obtain information about standard follow-up and treatment practices, and rheumatologists' aims in the care of patients with RA. METHODS: A survey conducted at the 2008 EULAR Congress. RESULTS: Most specialists, who were mainly from Europe and Latin America, were well-informed about recent concepts: two-thirds specified remission as a major goal. The experts attempted to reach treatment aims within 12-14 weeks, altering treatment otherwise. Disease activity assessment by composite measures is performed by a majority, although one-third preferentially relied upon their judgment. CONCLUSION: These results suggest the acceptance of ambitious treatment concepts in practice. Although voluntary surveys have limitations, the answers reflect widespread adoption of desirable standards of care.
19401359 Contemporary treatment principles for early rheumatoid arthritis: a consensus statement. 2009 Jul OBJECTIVE: RA has a substantial impact on both patients and healthcare systems. Our objective is to advance the understanding of modern management principles in light of recent evidence concerning the condition's diagnosis and treatment. METHODS: A group of practicing UK rheumatologists formulated contemporary management principles and clinical practice recommendations concerning both diagnosis and treatment. Areas of clinical uncertainty were documented, leading to research recommendations. RESULTS: A fundamental concept governing treatment of RA is minimization of cumulative inflammation, referred to as the inflammation-time area under the curve (AUC). To achieve this, four core principles of management were identified: (i) detect and refer patients early, even if the diagnosis is uncertain: patients should be referred at the first suspicion of persistent inflammatory polyarthritis and rheumatology departments should provide rapid access to a diagnostic and prognostic service; (ii) treat RA immediately: optimizing outcomes with conventional DMARDs and biologics requires that effective treatment be started early-ideally within 3 months of symptom onset; (iii) tight control of inflammation in RA improves outcome: frequent assessments and an objective protocol should be used to make treatment changes that maintain low-disease activity/remission at an agreed target; (iv) consider the risk-benefit ratio and tailor treatment to each patient: differing patient, disease and drug characteristics require long-term monitoring of risks and benefits with adaptations of treatments to suit individual circumstances. CONCLUSION: These principles focus on effective control of the inflammatory process in RA, but optimal uptake may require changes in service provision to accommodate appropriate care pathways.
19411387 Sick leave before and after diagnosis of rheumatoid arthritis--a report from the Swedish T 2009 Jun OBJECTIVE: Our study describes sick leave during 3 years before and 3 years after diagnosis of rheumatoid arthritis (RA) in relation to referents and identifies predictors for sick leave during the third year after diagnosis of RA. METHODS: One hundred twenty patients (76% women) from the Swedish early RA study TIRA were included. Disease activity and disability were registered regularly during 3 years in TIRA. Referents were matched for sex, age, and home town. Sick leave data were obtained for patients 3 years before and 3 years after diagnosis and for the referents for the corresponding 6 years. RESULTS: No differences were seen between patients and referents regarding sick leave during the first 2 years, whereas sick leave increased in patients 6 months before diagnosis, from 30% to 53%. During the 3 years after diagnosis, sick leave among patients was rather stable, varying between 50% and 60%, even though disability pension increased and sickness benefit decreased. Sick leave before diagnosis, disability 1 year after diagnosis, and type of work were identified as predictors for sick leave during the third year after diagnosis. CONCLUSION: Not surprisingly, sick leave in patients increased the year before diagnosis. Although disease activity and disability diminished after diagnosis, the patients' sick leave remained essentially unchanged. Sick leave 3 years after diagnosis was foremost predicted by earlier sick leave, disability, and type of work.
20952475 Prevalence of vitamin D insufficiency/deficiency in rheumatoid arthritis and associations 2011 Jan OBJECTIVE: 25-hydroxy-vitamin D (25-OH-D) insufficiency/deficiency is increasingly prevalent and has been associated with many chronic diseases, including rheumatoid arthritis (RA). Our purpose was to define the prevalence and associations of 25-OH-D insufficiency/deficiency in a cohort of US veterans with RA. METHODS: vitamin D status (25-OH-D) was assessed in patients with RA using radioimmunoassay on banked plasma collected at enrollment. Insufficiency was defined as concentrations < 30 ng/ml and deficiency as < 20 ng/ml. Associations of 25-OH-D insufficiency/deficiency with patient characteristics obtained at enrollment were examined using multivariate logistic regression, adjusting for age, sex, season of enrollment, and race. RESULTS: patients (850 men, 76% Caucasian) had a mean (SD) age of 64 (SD 11.3) years. The prevalences of 25-OH-D insufficiency and deficiency were 84% and 43%, respectively. After multivariate adjustment, both insufficiency and deficiency were more common with anti-cyclic citrullinated peptide antibody positivity and non-Caucasian race, and in the absence of vitamin D supplementation. 25-OH-D deficiency, but not insufficiency, was independently associated with higher tender joint counts and highly sensitive C-reactive protein levels. CONCLUSION: in a predominantly elderly, male RA population, 25-OH-D insufficiency was highly prevalent. With the increasing adverse health outcomes associated with hypovitaminosis D, screening and supplementation, particularly among minority, seropositive patients with RA, should be performed routinely.
19363565 Supervised aerobic exercise is more effective than home aerobic exercise in female chinese 2009 Apr OBJECTIVE: To compare the effectiveness and safety of supervised aerobic exercise and home aerobic exercise in female Chinese patients with rheumatoid arthritis. DESIGN: Single-blind randomized controlled trial. SUBJECTS: Thirty female Chinese patients with rheumatoid arthritis were assigned to either supervised aerobic exercise or home aerobic exercise groups. METHODS: The supervised aerobic exercise programme was supervised by a physical therapist, while the home aerobic exercise programme was performed at home after one session of exercise instruction. Each programme consisted of 1 h of aerobic exercise conducted 3 times per week for 8 weeks. Aerobic capacity and disease-related variables, including pain intensity, functional ability, psychological status and joint function, were measured. RESULTS: Significant difference in changed score between pre- and post-exercise data was observed between the supervised aerobic exercise and home aerobic exercise groups regarding aerobic capacity (p < 0.0001). Pre- and post-exercise within-group comparisons showed significant improvement (20%) in aerobic capacity only in the supervised aerobic exercise group. Pre- and post-exercise within-group comparison showed significant improvement in 5 and 3 items of disease-related variables in supervised aerobic exercise and home aerobic exercise groups, respectively. CONCLUSION: An 8-week supervised aerobic exercise programme induced significant improvement in the aerobic capacity of female Chinese patients with rheumatoid arthritis, and was superior to a home aerobic exercise programme. Both programmes of aerobic exercise were safe for female Chinese patients with rheumatoid arthritis.
20138855 The +49A>G CTLA-4 polymorphism is associated with rheumatoid arthritis in Mexican populati 2010 May 2 BACKGROUND: The Cytotoxic T lymphocyte antigen (CTLA-4) is one of the major susceptibility genes associated with autoimmune diseases. Susceptibility to rheumatoid arthritis (RA) is determined by both environmental and genetic factors. The genetic contribution approaches 50-60%. The association between RA with the +49A>G CTLA-4 polymorphism in the Mexican population was investigated. METHODS: The polymerase chain reaction-restriction fragment was used to amplify the +49A>G CTLA-4 polymorphism in RA patients and healthy subjects (HS). RESULTS: We analyzed the association between the +49A>G CTLA-4 polymorphism and RA. The G allele frequency was higher in RA patients than HS (46.8 vs 37.7%, OR=1.45, p=0.01). RA patients carrying the A/G genotype were significantly more likely to be positive to CRP and RF. There was no evidence of an association between SNP genotypes and the clinical characteristics of rheumatoid arthritis. CONCLUSIONS: The +49A>G CTLA-4 polymorphism is a genetic marker of susceptibility for RA in western Mexican population.
19054825 Elaboration of the preliminary Rheumatoid Arthritis Impact of Disease (RAID) score: a EULA 2009 Nov BACKGROUND: Current response criteria in rheumatoid arthritis (RA) usually assess only three patient-reported outcomes (PROs): pain, functional disability and patient global assessment. Other important PROs such as fatigue are not included. OBJECTIVE: To elaborate a patient-derived composite response index for use in clinical trials in RA, the RA Impact of Disease (RAID) score. METHODS: Ten patients identified 17 domains or areas of health relevant for inclusion in the score, then 96 patients (10 per country in 10 European countries) ranked these domains in order of decreasing importance. The seven most important domains were selected. Instruments were chosen for each domain after extensive literature research of psychometric properties and expert opinion. The relative weight of each of the domains was obtained from 505 patients who were asked to "distribute 100 points" among the seven domains. The average ranks of importance of these domains were then computed. RESULTS: The RAID score includes seven domains with the following relative weights: pain (21%), functional disability (16%), fatigue (15%), emotional well-being (12%), sleep (12%), coping (12%) and physical well-being (12%). Weights were similar across countries and across patient and disease characteristics. Proposed instruments include the Health Assessment Questionnaire and numerical ratings scales. CONCLUSION: The preliminary RAID score is a patient-derived weighted score to assess the impact of RA. An ongoing study will allow the final choice of questionnaires and assessment of validity. This score can be used in clinical trials as a new composite index that captures information relevant to patients.
20213090 [Rheumatoid arthritis and autoimmune hemolysis: B-cell depletion for remission induction i 2010 Aug Autoimmune hemolysis is a rare complication of systemic rheumatic diseases. We report on a 68-year-old female patient with established, long-standing rheumatoid arthritis, who complained of progressive weakness and worsening of her arthralgia under therapy with leflunomide. Physical and laboratory examination revealed autoimmune hemolysis due to cold agglutinin disease. As hemolysis and arthritis were refractory to steroid treatment, B-cell depletion with rituximab was performed leading to a marked reduction of hemolytic parameters as well as remission of her rheumatoid arthritis.
19825848 Impact of comorbidity on physical function in patients with rheumatoid arthritis. 2010 Mar BACKGROUND: Physical disability is a main outcome in rheumatoid arthritis (RA) which tends to increase with comorbidities. However, the extent to which comorbidities contribute to the multifactorial process of disability has not been investigated. OBJECTIVE: To quantify the contribution of comorbidity to physical disability in patients with RA. METHODS: In a prospective cohort study, age-adjusted Charlson comorbidity index (CCI(A)), serial measurements of disease activity and functional disability (evaluated by the Health Assessment Questionnaire Disability Index, HAQ) of 380 patients with established RA seen at an outpatient clinic over 1 year (June 2007 to July 2008) were ascertained. The association between comorbidity and physical disability was assessed using analysis of variance (ANOVA) and adjusted general linear regression models. RESULTS: Four patient groups with increasing levels of comorbidity (CCI(A) 0, 1-2, 3-4 and 5-9; potential range 0-38) were defined. Mean HAQ scores were significantly different across these groups (0.67, 0.80, 1.24, 1.40, respectively; p<0.001) and also when adjusted for disease activity, gender and disease duration in the regression model (0.84, 0.88, 1.14, 1.48, respectively; p<0.001). The effects of CCI(A) on disability were similar within different strata of disease activity: namely, remission (0.26, 0.31, 0.48 and 0.88, p<0.01); low disease activity (0.83, 0.78, 0.98 and 1.36, p<0.01); and moderate to high disease activity (1.22, 1.33, 1.70 and 1.91, p<0.01), and thus were independent of disease activity. Several sensitivity analyses, including the use of the Short Form Health Survey (SF-36), confirmed these observations. CONCLUSION: Physical disability becomes worse with increasing levels of comorbidity, irrespective of disease activity.
19437087 Does practice mirror the evidence base in the treatment of rheumatoid arthritis? 2009 Aug A large base of evidence exists regarding treatments for rheumatoid arthritis (RA) and how they may be used to preserve long-term function and improve patient outcomes. However, little is known about whether real-life rheumatology practice reflects the evidence base. This survey aimed to capture differing perceptions among rheumatologists in the identification and treatment of patients and to understand how their management of and treatment decisions for patients with RA may be influenced by the current published literature. Rheumatologists from five European countries and Canada participated in a survey between April and May 2006 to establish how rheumatologists identify and treat particular patient types in everyday practice. In total, 458 rheumatologists responded to the online and telephone survey. Rapidly progressing disease was overwhelmingly recognized (97%) as a distinct subtype among patients with RA, and the majority (88%) of respondents make treatment decisions based on this distinction. Most rheumatologists use measures including C-reactive protein, erythrocyte sedimentation rate, tender/swollen joint counts, and X-ray progression to diagnose and monitor this particular group of patients; a minority (30%) used magnetic resonance imaging to identify and monitor patients with rapidly progressing disease. Although treatment goals for these patients were similar among rheumatologists, the treatment approach varied considerably across countries. Overall, rheumatologists agree on the management goals for patients with rapidly progressing RA; however, their treatment patterns have some dissimilarities.
20108011 Radiographic measurements in the evaluation and classification of elbow joint destruction 2010 Jun We developed two new radiographic parameters-the humeral surface height ratio and ulnar surface height ratio-to precisely detect changes in the bony structure of rheumatoid elbows. Of the 59 patients with rheumatoid arthritis, 101 elbows were classified into four types (osteoarthritis, ankylosis, erosive, and resorptive) according to the radiographic appearance. Clinically, osteoarthritis type and ankylosis type were considered to be stable form, and erosive type and resorptive type were unstable form. Patients' clinical data and yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio were compared among the four types and between the two forms. There were significant differences between the two forms and among the three types except for the ankylosis type in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio. Stable and unstable forms were distinguished by a cut-off point of 0.65 and 2.58 in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and the ulnar surface height ratio, respectively. These parameters might be useful for monitoring the structural changes of the elbow joint in rheumatoid arthritis.
20821284 Approach to a child with monoarthritis. 2010 Sep Arthritis in childhood is common. The pattern, presentation and duration of arthritis help differentiate between the various possible diagnoses. When only one joint is involved, i.e., monoarthritis, it may be difficult to make a diagnosis as there are many possibilities both acute and chronic in nature. A detailed history and clinical examination is important to reach a correct diagnosis and the single most important investigation when a child presents acutely is a joint aspiration to rule out septic arthritis that may destroy the joint in hours. Inflammatory markers, antinuclear antibody testing, test for tuberculosis and imaging (in specific cases) play an important role in the diagnosis of a child that presents with a chronic monoarthritis. In this article we provide a clinical approach to the diagnosis of monoarthritis in a child.
20112843 Dyslipidaemia in rheumatoid arthritis in a tertiary care centre in Eastern India--a non-ra 2009 Jul Dyslipidaemia in rheumatoid arthritis, is associated with accelerated atherosclerosis. A nonrandomised trial was conducted to find out the proportion of rheumatoid arthritis patients suffering from dyslipidaemia and change in lipid levels after an intervention with antirheumatic drugs in a tertiary care centre in Eastern India from April 2006 to July 2008. The trial was done on 161 diagnosed patients of rheumatoid arthritis (fulfilling the American College of Rheumatology criteria) on lipid levels. Lipids estimations were done enzymatically by semi-autoanalyser and dyslipidaemia was defined by taking the cut-off value of National Cholesterol Education Programme-Adult Treatment Panel III (NCEP-ATP III) guidelines. Patients with other comorbid illness and on statins were excluded. Disease activity score 28 (DAS-28) was also employed for evaluating disease activity. Patients were followed up to 10 -12 weeks for repeat lipid level estimation. Using the high cut-off values of NCEP-ATP III, 39.1% of the patients showed dyslipidaemia in initial visit. Low high density lipoprotein cholesterol (HDL-C) was the commonest abnormality seen in 37.2%. In the follow-up study after getting disease modifying antirheumatic drugs (methotrexate, sulfasalazine, hydroxychloroquine) therapy, 19.9% patients had dyslipidaemia again and there were increase in total cholesterol, low density lipoprotein cholesterol, HDL-C but triglyceride was reduced. Low HDL-C again became the commonest (17.9%) and rise in HDL-C level was statistically significant. DAS-28 showed a good reduction and significant negative correlation with HDL-C. Lipid abnormalities, common in Indian patients with rheumatoid arthritis, are also observed in Eastern India. Low HDL-C being the commonest abnormality. Disease activity in rheumatoid arthritis is inversely related to the lipid levels.
19830383 Significance of anti-CCP antibodies in modification of 1987 ACR classification criteria in 2010 Jan To examine the incorporation of anti-CCP antibodies into the American College of Rheumatology (ACR) classification criteria for rheumatoid arthritis (RA) and to evaluate the advantages of the revised anti-CCP criteria in diagnosing Chinese patients. Patients who suffered from arthritic problems during the recent 2 years were selected from the Department of Rheumatology and Immunology of Peking University People's Hospital. The patients were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists. The ACR criteria were revised in three ways: (1) replacement of rheumatoid nodules and erosions as criteria with anti-CCP antibodies (RA-6 criteria); (2) replacement of rheumatoid nodules with anti-CCP antibodies as a criterion (RA-7 criteria); (3) addition of anti-CCP antibodies (RA-8 criteria). The diagnostic value of ACR criteria and anti-CCP revised criteria (RA-6, RA-7, and RA-8) were evaluated by comparing the sensitivity and specificity of all criteria, in all subjects and in subjects with arthritis symptoms within 2 years. There were 604 patients included in the study totally, among whom 312 patients were diagnosed as RA and 292 were diagnosed as other rheumatic diseases by rheumatologists. For all the RA patients, the sensitivity and specificity of anti-CCP antibodies were 76.2% and 96%, respectively. Its specificity was much higher than RF (85.2%). For the patients with a disease duration less than two years, the sensitivities were 82.0%, 91.0%, 87.0%, and 87.0%, while the specificities were 95.6%, 83.9%, 95.6%, and 95.6%, respectively, according to 1987 ACR criteria, RA-6, RA-7, and RA-8 criteria. Among all the RA patients, the corresponding sensitivities were 92.3%, 96.8%, 94.6%, and 94.6%, and the specificities were 92.8%, 83.6%, 92.8%, and 92.8%, respectively. The 1987 ACR criteria have high sensitivity and specificity in established RA, but are less sensitive in early RA. The RA-6 criteria improve the sensitivity by reducing its specificity. The RA-7 criteria with replacement of rheumatoid nodules by anti-CCP antibodies increase the sensitivity without losing specificity, which may serve as new classification criteria in routine clinical practice, especially in early RA patients.