Systemic literature review of the performance of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis: good news of debatable significance

Radner et al 1report the results of a systematic literature search analysing the numerous articles and conference proceedings which have examined the performance of the 2010 ACR/EULAR classification criteria for rheumatoid arthritis (RA). Their comprehensive evaluation determined whether the 2010 criteria were applied correctly in accordance with the original publication, explored the performance of the criteria as regards different methods for assessing the criteria components and using different reference standards, and finally, directly compared classification results obtained using the 2010 or the 1987 criteria. The overall sensitivity of the criteria was 82% and overall specificity was 61% when applied to the intended target population. Eight studies and five meeting abstracts directly compared the 1987 and 2010 criteria using different reference standards within different target populations. When patients with other diagnoses were excluded, the 2010 ACR/EULAR criteria demonstrated almost 21% higher sensitivity compared with the 1987 ACR criteria, although specificity was 16% lower. Therefore, Radner et al 1 conclude that the 2010 criteria are more sensitive than the 1987 criteria at the cost of a slight decrement in specificity, which might increase the possibility that a few non-RA patients are classified as RA patients and, for example, entered into clinical trials. Another recent systematic literature review and meta-analysis including six full papers and four abstracts reported an identical result, stating that the new classification criteria have good sensitivity, lower specificity and an overall moderate …