Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Leiden 2300 RC, The Netherlands.
Ann Rheum Dis. 2013 Apr;72(4):479-81. doi: 10.1136/annrheumdis-2012-202779. Epub 2013 Feb 2.
The aim of this report was to propose a definition for erosive disease in the context of inflammatory arthritis in light of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) criteria for use in clinical practice and studies. A EULAR task force was formed including 16 rheumatologists and one rheumatology fellow. The process was both evidence based and consensus based, and included, between March 2010 and April 2012, analyses of data from two cohorts, two face-to-face meetings, one online voting and one teleconference. The Leiden Early Arthritis Cohort and the French ESPOIR cohort were used for the evidence-based part. The outcome measures, which were initiation of methotrexate therapy, or any disease-modifying antirheumatic drug therapy within the first year of disease and arthritis persistency over 5 years, were studied with the aim to give the best definition of erosive disease. A decision was made to select a definition with a high specificity and focus on patients who did not otherwise fulfil the 2010 ACR/EULAR RA criteria (<6 points). By a unanimous vote the following definition was selected: erosive disease for use in the 2010 ACR/EULAR RA classification criteria is defined when an erosion (defined as a cortical break) is seen in at least three separate joints at any of the following sites: the proximal interphalangeal, the metacarpophalangeal, the wrist (counted as one joint) and the metatarsophalangeal joints on radiographs of both hands and feet. A highly specific definition for erosive disease has thus been formulated.
本报告旨在根据 2010 年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）类风湿关节炎（RA）标准，为炎症性关节炎中的侵蚀性疾病提出一个定义，以便在临床实践和研究中使用。一个 EULAR 工作组由 16 名风湿病专家和一名风湿病研究员组成。这个过程既基于证据，也基于共识，包括 2010 年 3 月至 2012 年 4 月期间对两个队列的数据进行分析、两次面对面会议、一次在线投票和一次电话会议。莱顿早期关节炎队列和法国 ESPOIR 队列被用于基于证据的部分。终点指标是在疾病开始的第一年开始使用甲氨蝶呤治疗或任何疾病修饰抗风湿药物治疗，以及 5 年内关节炎持续存在，目的是对侵蚀性疾病给出最佳定义。决定选择一个具有高特异性的定义，并关注那些不符合 2010 年 ACR/EULAR RA 标准（<6 分）的患者。一致投票选择了以下定义：在双手和双脚的 X 线片上，至少在以下三个部位的三个单独关节中看到侵蚀（定义为皮质断裂），则可使用 2010 年 ACR/EULAR RA 分类标准来定义侵蚀性疾病：近端指间关节、掌指关节、腕关节（算作一个关节）和跖趾关节。因此，制定了一个具有高度特异性的侵蚀性疾病定义。
