The authors also pointed out that symmetry is not a criterion for diagnosis, as it did not show significance in either phase of the new guidelines' development. Nevertheless, they wrote, “Inevitably,… the greater the number of involved joints the higher the likelihood of bilateral involvement.”
When Dr. Matteson was asked what was missing from the new guidelines, he pointed to a lack of awareness of extra-articular components of RA, which also can occur early in the course of the disease.
“When they do [occur], they can be very useful in identifying the disease, and they are important markers and predictors of disease severity and need for therapy,” he said.
The guidelines also lack biomarkers for treatment response, he added.
Several of the guideline authors disclosed financial and other relationships with multiple pharmaceutical companies; Dr. Matteson stated that he had no financial disclosures relative to his comments.