Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
21340502 Hemophagocytic syndrome in a patient with rheumatoid arthritis. 2011 Oct A 76-year-old man with rheumatoid arthritis, who had been treated with oral prednisolone and methotrexate, presented with high fever and generalized fatigability. Laboratory data demonstrated marked pancytopenia, which we first regarded as a side effect of methotrexate, and leucovorin was administered with granulocyte-colony stimulating factor and transfusions. Because no recovery was recognized, however, bone marrow aspiration was performed, by which hemophagocytic syndrome was diagnosed. After corticosteroid pulse therapy was initiated, the patient's symptoms were rapidly attenuated and laboratory data rapidly normalized.
21455121 Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE 2011 Apr BACKGROUND: The aim of this study was to assess and compare patients' access to biologic anti-RA drugs in selected Central and Eastern European (CEE) countries and to analyze the determinants of differences between countries. MATERIAL/METHODS: This is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using an affordability index, calculated comparing the index of health care expenditures to the price index, using Poland as an index of 1. RESULTS: The percentage of patients on biologic treatment in 2009 was highest in Hungary (5% RA patients on biologic treatment), followed by Slovenia (4.5%), Slovakia (3.5%), Czech Republic (2.92%), Romania (2.2%), Estonia (1.8%), and Croatia, Serbia, Poland (below 1.5%). Infliximab, etanercept, adalimumab and rituximab were included in the reimbursement system in all countries, but abatacept and tocilizumab were included only in Slovakia. In Slovenia, public payer covered 75% of the price, and 25% is covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries, biologic drugs are reimbursed at 100%. Affordability index for biologic drugs was the lowest in Slovenia (0.4). In each country national guidelines define which patients are eligible for biologic treatment. Disease Activity Score (DAS28) of over 5.1 and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria. CONCLUSIONS: The most important factors limiting access to biologic anti-RA treatment in the CEE region are macroeconomic conditions and restrictive treatment guidelines.
21622765 Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibi 2011 Sep OBJECTIVES: To investigate whether bone erosions in patients with rheumatoid arthritis (RA) show evidence of repair. METHODS: 127 erosions were identified in metacarpophalangeal joints 2-4 of the right hands of 30 RA patients treated with tumour necrosis factor inhibitors (TNFi) and 21 sex, age and disease activity-matched patients treated with methotrexate. All erosions were assessed for their exact maximal width and depth by high-resolution µCT imaging at baseline and after 1 year. RESULTS: All erosions detected at baseline could be visualised at follow-up after 1 year. At baseline, the mean width of bone erosions in the TNFi group was 2.0 mm; their mean depth was 2.3 mm, which was not significantly different from the methotrexate-treated group (width 2.4 mm; depth 2.4 mm). Mean depth of erosions significantly decreased after 1 year of treatment with TNFi (-0.1 mm; p=0.016), whereas their width remained unchanged. In contrast, mean depth and width of erosive lesions increased in the methotrexate-treated group. The reduction in the depth of lesions was confined to erosions showing evidence of sclerosis at the base of the lesion. Moreover, deeper lesions in the TNFi group were particularly prone to repair (-0.4 mm; p=0.02) compared with more shallow lesions. CONCLUSIONS: Bone erosions in RA patients treated with TNFi show evidence of limited repair in contrast to bone erosions in patients treated with methotrexate. Repair is associated with a decrease in the depth of lesions and sclerosis at the bases of the lesions. Repair thus emerges from the endosteal rather than periosteal bone compartment and probably involves the bone marrow.
23070990 Effect of rheumatologist education on systematic measurements and treatment decisions in r 2012 Dec OBJECTIVE: To determine whether an educational intervention could result in changes in physicians' practice behavior. METHODS: Twenty rheumatologists performed a prospective chart audit of 50 consecutive patients with rheumatoid arthritis (RA) and again after 6 months. Ten were randomized to the educational intervention: monthly Web-based conferences on the value of systematic assessments in RA, recent evidence-based information, practice efficiency, and other topics; this group also read articles on targeting care in RA. The others were randomized to no intervention. RESULTS: One thousand serial RA charts were audited at baseline and 1000 at 6 months, with no between-group differences in patient characteristics: mean disease duration of 10 years; 77% women; 74% rheumatoid factor- positive; mean Disease Activity Score (DAS) 3.7; and 68% taking methotrexate, 14% taking steroids, and 27% taking biologics. At 6 months the intervention group collected more global assessments (patient global 53% preintervention vs 66% postintervention, and MD global 51% vs 60%; p < 0.05) and Health Assessment Questionnaires (37% vs 42%; p > 0.05; p = nonsignificant), whereas controls had no change in outcomes collected. For the intervention group there was a 32% increase in calculable composite scores [such as DAS, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index; p < 0.05] but no change in the controls. There was more targeting to a low disease state. For those with SDAI between 3.3 and 11, the percentage of patients receiving a change in therapy was 66% in the intervention group and 36% in controls (p < 0.05). When DAS was between 2.4 and 3.6, 57% of the intervention group and 38% of controls made changes to treatment (p < 0.05). CONCLUSION: Small-group learning with feedback from practice audits is an inexpensive way to improve outcomes in RA.
21285117 Performance of the 2010 ACR/EULAR criteria for rheumatoid arthritis: comparison with 1987 2011 Jun OBJECTIVE: Early 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. METHODS: Data 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. RESULTS: 265 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). CONCLUSION: The 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.
22131049 Metrologic properties of ultrasound versus clinical evaluation of synovitis in rheumatoid 2012 Apr OBJECTIVE: To evaluate the intraobserver reliability, face validity, and discriminant capacity of different global ultrasound (US) scoring systems for measuring synovitis in rheumatoid arthritis (RA). METHODS: This study was ancillary to a 52-week, multicenter, prospective, randomized, open-label, parallel-group outpatient study conducted in patients with moderate RA who were randomized to receive either etanercept combined with methotrexate or various disease-modifying antirheumatic drugs. A total of 66 different synovitis scoring systems were constructed and evaluated, including 11 different joint combinations; data derived from clinical findings, gray-scale US, and power Doppler US (PDUS); and both binary counts and semiquantitative scores. RESULTS: Due to discontinuation of the trial, only 62 patients, a subset of the initially planned number of patients, were included in this study. Reliability was found to be better for gray-scale US and PDUS than for clinical evaluation of synovitis in patients with stable disease between the screening and baseline visits (range for intraclass correlation coefficient 0.6, 0.95 for gray-scale US and 0.56, 0.93 for PDUS versus 0.31, 0.75 for clinical indices). The median (range) difference in the discriminant capacities of clinical indices versus gray-scale US and versus PDUS was 0.25 (-0.64, 0.96) and -0.025 (-0.59, 0.53), respectively, in the period from baseline to 12 weeks. No relevant differences in metrologic properties were observed regarding the number and composition of joints between the different scoring systems. Our findings suggested that a simplified scoring system referring to gray-scale US and PDUS findings might be sufficient. CONCLUSION: Our findings indicate that gray-scale US and PDUS have better reliability than generally used clinical indices for evaluating synovitis in RA. PDUS has at least as good discriminant capacity as clinical assessment of synovitis for distinguishing between treatment arms.
21773884 Methylenetetrahydrofolate reductase polymorphisms, C677T and A1298C, are associated with m 2012 Jun We investigated associations between the methylenetetrahydrofolate reductase (MTHFR) polymorphisms C677T and A1298C and methotrexate (MTX)-related toxicities in Korean patients with rheumatoid arthritis (RA) taking MTX. One hundred sixty-seven patients with RA were enrolled in a cross-sectional study and genotyped for the single-nucleotide polymorphisms C677T and A1298C in MTHFR. Alleles, genotypes, and haplotypes of the C677T and A1298C polymorphisms were not associated with specific MTX toxicities. However, among RA patients with the 1298CC genotype, the proportion who experienced at least one toxicity was significantly greater than the proportion of patients with 1298AA who did (P = 0.043). In addition, the proportion of patients with the 677C/1298A haplotype who experienced toxicity was greater than the proportion of those with 677C/1298C who did (P = 0.032, odds ratio = 2.085, 95% confidence interval 1.058-4.106). In this study, MTHFR polymorphisms were associated with MTX toxicities in Korean patients with RA. Further study for association of MTHFR polymorphisms with MTX toxicities should be needed in larger RA population.
22661552 Evidence of the symptomatic and structural efficacy of methotrexate in daily practice as t 2012 Sep OBJECTIVE: To describe the use of MTX in early arthritis (EA) in daily clinical practice and to evaluate its 6-month symptomatic efficacy and 12-month structural efficacy. METHODS: Patients included in the French observational ESPOIR cohort were assessed. Evaluation of the symptomatic and structural efficacy was performed by generalized linear regression after adjustment on propensity score (PS) in the group of patients receiving at least 3 months of MTX vs the ones receiving any other treatment except LEF, SSZ or TNF inhibitors. RESULTS: Within the first 6 months of follow-up of 777 EA patients, 59% received a DMARD, which was MTX in 68% (N = 313) of patients. The mean dose of MTX was 12.7 ± 3.8 mg/week. Only 53.7% of the patients received folic acid supplementation. MTX was initiated in patients with more active and severe disease. At 6 months, in unadjusted analysis, patients starting MTX had a significantly higher DAS-28 (3.58 vs 3.23; P = 0.001) and a significantly higher HAQ (0.60 vs. 0.48; P = 0.01) compared with controls. After adjustment by PS, there were no significant differences. Adjustment for the PS also revealed a statistically significant decrease in the radiological progression at 12 months in the MTX group [total Sharp-van der Heijde score (SHS), 1.05 ± 0.29 vs 2.02 ± 0.29, P = 0.025]. CONCLUSION: This study confirms the symptomatic and structural efficacy of MTX in EA in daily practice despite the non-optimal use of MTX, including low doses and infrequent concomitant folic acid supplementation.
23013848 Occurrence of rheumatoid arthritis requiring oral and/or biological disease-modifying anti 2012 Oct We report 6 patients with an established diagnosis of primary Sjögren syndrome who developed severe rheumatoid arthritis (RA) requiring oral disease-modifying antirheumatic drug with or without biologic therapy. Rheumatoid arthritis was diagnosed between 14 months and 17 years following initial sicca symptoms. Five patients were female. Two thirds were seropositive for Sjögren antibody, and 5 of 6 were either rheumatoid factor or anti-cyclic citrullinated peptide positive at the time of RA diagnosis. All had either hand or wrist involvement; one third had nodules. Although none demonstrated erosion on x-ray, all required methotrexate or leflunomide, and 4 required a biologic agent for the treatment of their arthritis. Primary Sjögren patients may develop RA after a long course of stable Sjögren.
21893001 [Methotrexate treatment of rheumatoid arthritis in Denmark]. 2011 Sep 5 In the recommended early, aggressive and continuous treatment strategy of rheumatoid arthritis (RA), methotrexate (MTX) is the anchor drug, and although generally well tolerated approximately 50% of the RA patients discontinue MTX treatment within five years. In a large Danish cohort study among newly diagnosed patients with RA only 21% had started MTX treatment within 90 days after referral to hospital and the median time-to-treatment initiation was 120 days. Furthermore, MTX compliance is considered generally high among Danish RA patients and the patients have strong beliefs about MTX necessity.
21125279 Eruptive molluscum contagiosums in a patient with rheumatoid arthritis and lung cancer. 2011 Aug A 67-year-old woman with rheumatoid arthritis (RA) treated with systemic prednisolone and methotrexate over 20 years developed eruptive molluscum contagiosums on the trunk and extremities. Investigation revealed lung cancer 2 years later. Newly development of molluscum contagiosums ceased after the surgical operation of lung cancer. Immunologic dysfunctions have been shown in RA, and especially patients under long-term methotrexate therapy are susceptible to miscellaneous skin conditions. Eruptive molluscum contagiosums are induced in association with hematologic malignancies such as lymphoma, leukemia, and HIV infection; however, it is important to investigate internal malignancies, not only hematologic malignancies but also solid cancers, when patients with RA under immunosuppressive therapies presented eruptive or disseminated molluscum contagiosums.
20403067 Disease-modifying anti-rheumatic drug usage, prescribing patterns and disease activity in 2011 Jun AIMS: Our aim was to examine the spectrum of disease activity and usage of disease-modifying anti-rheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients seen over a period of 12 months in community-based rheumatology practice. METHODS: Data were prospectively collected on 1059 consecutive RA patients who attended two private, community-based rheumatology clinics from 1 May 2007 to 1 May 2008. Information on patient demographics, medication history and disease activity was collected. Life table graphs were developed to track medication retention over time. Statistical significance was determined by log-rank tests. RESULTS: One thousand and fifty-nine patients with RA were entered into the database over a 12-month period. Eight hundred and twenty-six patients (85%) were treated with single or combination conventional DMARD compared with 159 patients (15%) on a biologic DMARD either alone or in combination. Methotrexate monotherapy was the most commonly prescribed DMARD, used in 41% of patients studied. Almost half (47%) were on combination DMARD therapy. Methotrexate and tumour necrosis factor inhibitors had the highest retention rate over 12 and 30 months since first prescription. A large proportion of patients (47%) had moderate disease activity. CONCLUSION: Rates of biologic DMARD usage were similar to other studies and the predominance of methotrexate use was also in keeping with current recommendations for management of RA. There appears to be a significant unmet need for improved disease control among RA patients with moderate disease activity, which requires further investigation.
22460407 2012 Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis 2012 Mar OBJECTIVE: To elaborate recommendations for the treatment of rheumatoid arthritis in Brazil. METHOD: Literature review with articles' selection based on evidence and the expert opinion of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology. RESULTS AND CONCLUSIONS: 1) The therapeutic decision should be shared with the patient; 2) immediately after the diagnosis, a disease-modifying antirheumatic drug (DMARD) should be prescribed, and the treatment adjusted to achieve remission; 3) treatment should be conducted by a rheumatologist; 4) the initial treatment includes synthetic DMARDs; 5) methotrexate is the drug of choice; 6) patients who fail to respond after two schedules of synthetic DMARDs should be assessed for the use of biologic DMARDs; 7) exceptionally, biologic DMARDs can be considered earlier; 8) anti-TNF agents are preferentially recommended as the initial biologic therapy; 9) after therapeutic failure of a first biologic DMARD, other biologics can be used; 10) cyclophosphamide and azathioprine can be used in severe extra-articular manifestations; 11) oral corticoid is recommended at low doses and for short periods of time; 12) non-steroidal anti-inflammatory drugs should always be prescribed in association with a DMARD; 13) clinical assessments should be performed on a monthly basis at the beginning of treatment; 14) physical therapy, rehabilitation, and occupational therapy are indicated; 15) surgical treatment is recommended to correct sequelae; 16) alternative therapy does not replace traditional therapy; 17) family planning is recommended; 18) the active search and management of comorbidities are recommended; 19) the patient's vaccination status should be recorded and updated; 20) endemic-epidemic transmissible diseases should be investigated and treated.
19851770 Anaplastic large cell lymphoma in a patient with rheumatoid arthritis. 2011 Apr It is known that patients with rheumatoid arthritis (RA) have an increased risk for non-Hodgkin's lymphomas in comparison with the general population. Although increased risk of lymphoma is attributed to the disease activity, the drugs used in the therapy of RA may also cause increased risk of malignancy. Herein, we report on an RA patient who developed non-Hodgkin's lymphoma after methotrexate therapy and review the literature about it. A 74-year-old man with RA had been treated with low-dose methotrexate and subsequently developed anaplastic large cell lymphoma of the T-cell phenotype. Anaplastic large cell lymphoma has been reported rarely in rheumatoid arthritis.
22612739 Anti citrullinated protein antibodies and mechanism of action of common disease modifying 2012 The increasing understanding of autoimmune mechanisms continuously leads to new therapeutic targets and development of novel diagnostic tools in rheumatology. On the other hand, an improved comprehension of mechanisms of action of many drugs and the daily utilization in rheumatology leads to a better understanding of the underlying autoimmune processes. An example for the latter is Bcell depletion using anti-CD20 antibodies, which leads to the concept of B cells not only playing a role as antibody secreting cells but also as important cellular components of autoimmune processes, acting as antigen presenting and cytokine producing cells. Another example is the conventional disease modifying anti-rheumatic drug methotrexate, which has also been used successfully in the clinic first and then, while trying to understand its mechanism of action, led to knew insights in autoimmune mechanisms e.g. revealing the strong anti-inflammatory potential of adenosine. But not only the mechanism of action of different drugs, but also the identification of antibodies against citrullinated proteins (ACPA) as a valuable diagnostic tool resulted in novel concepts regarding the pathophysiology of rheumatoid arthritis. The following review first explains the value of ACPA in the diagnosis of rheumatoid arthritis (RA) and then summarizes the application and mechanism of action of several important substances used in the management of autoimmune disorders. Based on these insights, the authors explain their understanding of the autoimmune process as a continuous repeat of autoantigen presentation - autoreactive effector cell activation - destruction of tissue - liberation of new autoantigens - and again autoantigen presentation, which closes the vicious circle.
21951026 A case report of a 53-year-old female with rheumatoid arthritis and osteoporosis: focus on 2011 Sep A 53-year-old female presented with rheumatoid arthritis and osteoporosis. Additional conditions and symptoms included Raynaud syndrome, fatigue, irritable bowel syndrome associated constipation (IBS-C), gastroesophageal reflux (GERD), menopausal symptoms, chronic urinary tract and upper respiratory infections, and weight gain. She was taking Arthrotec (a combination of diclofenac and misoprostol - for pain and inflammation), Fosamax Plus D (alendronate with vitamin D3 - recently prescribed because of low bone density), and Catapres (clonidine - for menopausal symptoms). Against the advice of her rheumatologist, she had recently discontinued taking Plaquenil (hydroxychloroquine), methotrexate, and prednisone due to significant side effects. Lab tests to identify underlying imbalances and to direct treatment were ordered. Treatment included dietary, nutritional, hormonal, and mind/body support. After one year of therapy, the patient experienced improvement with all of her presenting conditions and symptoms, which enabled her to discontinue several medications. She became versed in identifying and avoiding the environmental triggers of her disease, including foods (dairy, wheat, eggs, and soy), molds, and emotional stress. Antinuclear antibodies were normalized. She experienced a 7.5-percent improvement in left trochanteric bone density - comparable to bisphosphonate therapy. Mild improvements were also noted in the spine and bilateral femoral neck.
21901356 Reactivation of hepatitis B virus in a hepatitis B surface antigen-negative patient with r 2012 Jun Immunosuppressive therapy can induce viral reactivation in patients with chronic hepatitis B virus (HBV) infection and, more rarely, in patients with resolved HBV infection. We report the case of a 57-year-old Japanese woman with rheumatoid arthritis (RA) who developed de-novo hepatitis B virus-related hepatitis after methotrexate (MTX) therapy. Entecavir and oral prednisolone following steroid pulse therapy were administered and her liver function recovered. MTX is widely used for RA for its efficiency and safety. But some cases of HBV reactivation caused by MTX, including de-novo hepatitis, have been reported. Considering these conditions, more attention should be paid when using MTX in patients with RA. And more studies are needed to determine who needs screening of HBV, monitoring of HBV-DNA, and prophylaxis with chemotherapy or immunosuppressive therapy.
21894776 [Methotrexate-related lymphomatoid granulomatosis in a patient with rheumatoid arthritis]. 2011 Aug A 76-year-old man who was taking prednisolone and methotrexate for rheumatoid arthritis presented with gastric ulcers. Chest X-ray images showed multiple pulmonary nodules. Transbronchial lung biopsy specimens showed lymphocytic infiltrates but no malignant cells. The radiographic findings gradually ameliorated over a month, but then deteriorated 5 months later. We performed video-assisted thoracoscopic biopsy of the left lung, and the biopsy specimens showed lymphocytic infiltration with necrosis, in which the atypical lymphocytes were positive for Epstein-Barr virus-encoded small RNAs in situ hybridization (EBER-ISH). A diagnosis of lymphomatoid granulomatosis was determined. One year before this diagnosis, the patient was found to have an inflammatory liver tumor that had disappeared spontaneously within a month. A new pathological review of the liver and stomach lesions demonstrated EBER-ISH-positive lymphocytes, and therefore we assumed that they were pathological features of lymphomatoid granulomatosis. The chest radiographic findings improved gradually after the discontinuation of methotrexate. We therefore suggest that methotrexate treatment may be associated with the development of lymphomatoid granulomatosis in patients with rheumatoid arthritis. Lymphoproliferative disorders, including lymphomatoid granulomatosis, should be considered in patients with rheumatoid arthritis who are receiving methotrexate.
22994096 [Single-photon emission computed tomography in the diagnosis of myocardial perfusion abnor 2012 Increased cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA) may be attributed to the fact that a systemic inflammation existing in this disease may trigger the development of atherosclerosis. 99mTC-MIBI (4,2-methoxyisobutyl isonitrile) is a compound that permits myocardial perfusion to be visualized and has been proposed for the evaluation of the latter in patients with RA. Analysis of the results of the studies revealed transient myocardial ischemia areas in patients who did not take methotrexate while those who used it were found to have diminished perfusion areas that were, however, clinical insignificant.
22704895 Comparison of the 1987 ACR criteria and the 2010 ACR/EULAR criteria in an inception cohort 2012 May OBJECTIVES: To compare the performance of the 1987 American College of Rheumatology (ACR) and the 2010 ACR/European League Against Rheumatism criteria for the classification of rheumatoid arthritis (RA). METHODS: Two-hundred and one patients aged 16 years or older with a 4-week to 12-month history of swelling of at least two joints and not previously treated with corticosteroids or disease-modifying anti-rheumatic drugs (DMARDs) were studied. The fulfilment of the 1987 and 2010 criteria was determined at baseline and at the end of the 1-year follow-up period. The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and accuracy of both sets of criteria were determined against three outcome measures: initiation of therapy with either methotrexate or any DMARD within the first year of follow-up, and clinical diagnosis according to physician's opinion after one year. RESULTS: At presentation, 145 patients fulfilled the 2010 criteria, and 108 the 1987 criteria for RA. The sensitivity, specificity and accuracy of the 2010 criteria were 0.80, 0.62 and 0.77 (0.58, 0.64 and 0.59 for the 1987 criteria) against the initiation of methotrexate therapy, 0.75, 0.73 and 0.75 (0.56, 0.91; 0.58 for the 1987 criteria) against the initiation of any DMARD therapy, and 0.87, 0.73 and 0.84 (0.69, 0.94; 0.75 for the 1987 criteria) against clinical diagnosis. CONCLUSIONS: Compared with the 1987 criteria, the 2010 criteria are more sensitive and accurate, but less specific against two of the three outcome measures used, and classify more patients with RA at earlier stages of the disease.