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1987 미국 류마티스 학회 개정
1. 진단 기준
2. Classification tree
3. ACR classification criteria for Determining Progression of Rheumatoid Arthritis
4. ACR Classification Criteria for Determinining Clinical Remission in Rheumatoid Arthritis
b. No fatigue
c. No joint pain
d. No joint tenderness or pain on motion
e. No soft tissue swelling in joints or tendon sheaths
f. ESR (Westergren methold) < 30 mm/hour for a female or 20 mm/hour for a male
Exclusions: Clinical manifestations of active vasculitis, pericarditis, pleuritis or myositis, and unexplained recent weight loss or fever attributable to rheumatoid arthritis will prohibit a designation of complete clinical remission.
Reference: Pinals RS, et.al.: Arthritis Rheum 24:1308, 1981.
5. ACR Classification Criteria of Functional Status in Rheumatoid Arthritis
Class II: Able to perform usual self-care and vocational activities, but limited in avocational activities
Class III: Able to perform usual self-care activities, but limited in vocational and avocational activities
Class IV: Limited ability to perform usual self-care, vocational, and avocational activities
*Self-care activities include dressing, feeding, bathing, grooming, and toileting. Avocational (recreational and/or leisure) and vocational (work, school, homemaking) activities are patient-desired and age- and sex-specific.
Reference: Hochberg MC, et.al.: Arthritis Rheum 35:498, 1992.
6. ACR Guidelines for Medical Management of Rheumatoid Arthritis (updated April, 2002)
7 ACR Definition of Improvement in RA trials
In the past, the outcome criteria used in clinical trials to determine the effectiveness of new agents has varied making the comparison between agents and between clinical trials difficult. Two well accepted composite measures of improvement have emerged-the Paulus Criteria and The American College of Rheumatology Criteria (ACR). ACR criteria is rapidly becoming the current gold standard.
The level of improvement is set as a percentage improvement of each of these variables i.e. a Paulus 20 classification indicates a responder who has shown 20% improvement in 4 of the 6 parameters.
Improvement is denoted as either ACR 20, ACR 50 or ACR 70 reflecting either an improvement to the 20%, 50%, or 70% level in the parameters outlined. The ACR Success criteria (20, 50, 70) requires that the patient complete the trial and the patient meet ACR responder at the end of the trial.
7. ACR Recommendations for Monitoring Hepatic Safety in Rheumatoid Arthritis (RA) Patients Receiving Methotrexate (MTX)
1. Baseline
2. Monitor AST, ALT, albumin at every 4-8 weeks
3. Liver biopsy should be performed if:
4. If results of liver biopsy are:
5. Discontinue MTX in patient with persistent liver test abnormalities, as defined in 3, who refuses liver biopsy.
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