New Rheumatoid Arthritis Classification System
In 2010, the American College of Rheumatology (ACR) updated its classification system for rheumatoid arthritis to help identify and treat patients in earlier stages of the disease. Under the old system, patients were not diagnosed with RA until joint damage was evident. The new classification system uses a 10-point analysis that includes factors such as symptom duration, and number and size of inflamed joints. Current treatment goals are designed to prevent patients with early RA from reaching the stage where chronic RA causes joint damage.
Drug Treatment Guidelines
Rheumatoid arthritis is treated with disease-modifying anti-rheumatic drugs (DMARDS), which include both nonbiologic and biologic medications. Current guidelines for drug treatment recommend:
- Methotrexate (Rheumatrex) or leflunomide (Arava) as initial therapy for most patients with RA
- Methotrexate plus hydroxychloroquine (Plaquenil) for patients with moderate-to-high disease activity
- Methotrexate plus hydroxychloroquine plus sulfasalazine (Azulfidine) for patients with poor prognostic features and moderate-to-high levels of disease activity.
- For patients with early RA (less than 3 months), anti-TNF drugs (along with methotrexate) should be reserved only for patients with high disease activity who have never received DMARDs. For longer duration RA, anti-TNF biologic drugs are recommended for patients who have not been helped by methotrexate.
- The biologic DMARDs abatacept (Orencia) and rituximab (Rituxan) should be reserved for patients with at least moderate disease activity and poor disease prognosis who were not helped by methotrexate and other nonbiologic DMARDs.
Review Date: 02/16/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.