EULAR Criteria and Treatment Recommendations for Rheumatoid Arthritis

Joint Involvement Classification

According to the 2010 ACR/EULAR classification criteria for rheumatoid arthritis, involvement of 1 large joint scores 0 points, while involvement of 2-10 large joints scores 1 point. 1

EULAR recommends that treatment should begin immediately after RA diagnosis to prevent disease progression. 1, 2
EULAR recommends that the treatment target should be sustained remission or low disease activity in every patient with rheumatoid arthritis. 2
EULAR recommends frequent monitoring in active disease (every 1-3 months); if no improvement by 3 months or target not reached by 6 months, therapy should be adjusted. 2
EULAR recommends methotrexate as part of the first treatment strategy for rheumatoid arthritis. 2
For patients with contraindications to methotrexate, EULAR recommends leflunomide or sulfasalazine as first-line treatment options. 2
EULAR recommends that short-term glucocorticoids should be considered when initiating or changing conventional synthetic DMARDs, but should be tapered as rapidly as clinically feasible. 2

ACR/EULAR remission definition is preferred over DAS28<2.6, which is not considered sufficiently stringent for determining true clinical remission. 1, 3

EULAR defines difficult-to-treat RA as requiring signs of active/progressive disease despite appropriate treatment. 1
EULAR criteria for difficult-to-treat RA include treatment according to recommendations with failure of ≥2 b/tsDMARDs with different mechanisms of action after failing csDMARD therapy, and management of signs/symptoms perceived as problematic by rheumatologist and/or patient. 4

The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) recommends a score-based algorithm requiring ≥6/10 points for definite classification of Rheumatoid Arthritis (RA), with target population including patients with at least one joint with definite clinical synovitis not better explained by another disease 5, 6
The 2010 ACR/EULAR classification criteria include four scoring domains: joint involvement, serology, acute phase reactants, and duration of symptoms, with a score of ≥6/10 points required for definite classification of RA 5, 7
Patients with erosive disease typical of RA with compatible history should be classified as having RA, and patients with long-standing disease who previously fulfilled the criteria should be classified as having RA 5, 8

The American College of Rheumatology recommends quantitative assessment using composite measures, including Disease Activity Score using 28 joint counts (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI), for monitoring and treatment decisions 6, 9
The primary goal of treatment is clinical remission or low disease activity, with early diagnosis and treatment critical to prevent joint destruction and disability 9

Extra-articular manifestations can affect multiple organ systems, including the lungs, heart, and eyes, and systemic inflammation contributes to comorbidities including accelerated cardiovascular disease 9
Regular assessment and treat-to-target strategies improve outcomes, and failing to consider differential diagnoses can lead to misdiagnosis 5, 8, 9