Page 14 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 1
several sets of classi cation criteria have been developed over the years. Of these, the 1987 the American College of Rheumatology (ACR) criteria have been applied for many studies worldwide.9 The 1987 ACR criteria for classi cation of RA include: morning stiffness, the number of affected joints, the location of the affected joint areas, symmetry of arthritis, the presence of rheumatoid nodules, the presence of serum RF, and radiographic changes. When 4 out of 7 criteria are present for six or more weeks, a patient is considered having certain RA.9
In 2010, a new set of classi cation criteria was developed to allow for early recognition of possible RA, and consequently for early start of anti-rheumatic treatment: the 2010 ACR/European League Against Rheumatism (EULAR) classi cation criteria.5 When applying these criteria, points are assigned to the number of large or small joints involved, the presence of low-positive or high-positive RF or ACPA, abnormal C-reactive protein (CRP) levels or erythrocyte sedimentation rate (ESR), and the duration of symptoms ≥6 weeks. When a patient has 6 or more points, a diagnosis of de nite RA can be made.5
Disease activity score
To compare disease course between patient groups and monitor patients’ responses to anti-rheumatic therapy, RA disease activity can be measured using the Disease Activity Score (DAS) with a 44 joint count, or the modi ed DAS28 using a 28 joint count.12 Aside from the tender and swollen joint count, the DAS also includes the ESR or the serum CRP level, and optionally a visual analogue scale for global health (GH). By selecting the items included in the DAS, the score can be adjusted to speci c situations, such as pregnancy. Overall changes in ESR and GH scores in pregnant women may influence the DAS. It has been shown, that the DAS28-CRP without GH component, is the least affected by pregnancy itself.13 The DAS28 ranges from 0 to 10, indicating how active the RA is at that moment. Remission criteria have also been developed, with patients with a DAS28 below 2.6 being considered in remission.14
Anti-rheumatic treatment
To prevent or limit long-term damage due to RA, the current EULAR guideline (2010) recommends the start of anti-rheumatic drugs as soon as a patient is diagnosed, or when a diagnosis of RA is suspected. The guideline describes a treat-to-target regimen with synthetic disease modifying anti-rheumatic drugs (DMARDs) as rst step treatment after the diagnosis of RA.15 Anti-rheumatic therapy should aim at disease
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