2012 challenges in rheumatoid arthritis care.

Update on RA diagnosis and management All aspects of the medical management of RA have undergone major changes in the past 25 years. In the 1990s numerous articles reported on the early onset of structural damage in patients with early RA that, if unchecked, would result in disability over time in >50% of patients. As a result, there was a shift to early aggressive therapy in hopes of improving patient outcomes and prevention of radiographic progression. This led to efforts to identify patients earlier in the disease and, with the advent of targeted biologic therapies to complement our non-biologic DMARDs, the opportunity for improvements in patient outcomes became a reality. With the availibility of additional treatment options, the objectives of treatment have themselves changed, from relief of disease symptoms to arresting the disease process itself. And, in line with the changes in medical management, it has become necessary to redefine the disease, including the criteria for classifying a patient as having RA, the way disease activity is measured and the criteria for remission. This supplement offers a comprehensive picture of where RA management stands today with respect to all of these issues. In their article on ACR/EULAR 2010 rheumatoid arthritis classification criteria [1], Kay and Upchurch discuss the rationale for updating the RA classification criteria by working committees of the ACR and the European League Against Rheumatism (EULAR), as well as the process that resulted in the development of these criteria. As will be discussed, the previous criteria, dating from 1987 and put forward by the ARA (now the ACR), emphasized factors that distinguished RA from other conditions that present with joint pain and served to identify patients with established RA, but failed to identify many patients with early disease who could have benefited from aggressive intervention. In contrast, the 2010 classification aims specifically to identify patients early in their disease course who are at high risk for disease progression. From the standpoint of RA management, it is necessary to assess the potential strengths and weaknesses of the new criteria, with the possibility that employing these criteria may result in either under-or overdiagnosis of RA. In the article by Bykerk and Massarotti on the new ACR/ EULAR classification criteria for RA [2], several recent studies that compare these criteria with other standards for the definition of RA in different populations are examined. Because of advances in medical management that result …