diagnostic criteria for rheumatoid arthritis (RA)

Introduction

1987 Revised criteria: (any 4 of 7 make the diagnosis of RA)*

• morning stiffness (at least 1 hr)
• arthritis of 3 or more joints [i.e. synovitis or joint effusion in any of the following 14 sites (L or R): PIP, MCP, wrist, elbow, knee, ankle, MTP]
• arthritis of hand or wrist joints [i.e. synovitis in wrist, MCP, or PIP]
• symmetric arthritis [i.e. simultaneous involvement of the same joint bilaterally, involving at least 2 different areas].
• rheumatoid nodules
• serum rheumatoid factor
• radiographic changes [i.e. bony decalcifications with erosions in typical areas for RA]

*symptom duration at least 6 weeks

Score-based algorithm for classification criteria for RA

• joint involvement (swollen or tender)
  • large joint (shoulders, elbows, hips, kneess, ankles) = 0
  • 2-10 large joints = 1
  • 1-3 small joints (with or without large joint) = 2
  • 4-10 small joints (with or without large joint) = 3
  • > 10 joints (at least 1 small joint) = 5
• serology (at least 1 test result needed for classification)
  • negative RF & negative anti-CCP Ab
  • low positive RF or low positive anti-CCP Ab = 2
    • level 1-3 times upper limit of reference interval
  • high positive RF or high positive anti-CCP Ab = 3
    • level >3 times upper limit of reference interval
• acute phase reactants (at least 1 test result needed for classification)
  • normal ESR & normal serum C-reactive protein = 0
  • elevated ESR & abnormal elevated C-reactive protein = 1
• duration of joint symptoms (patient self report)
  • < 6 weeks = 0
  • > 6 weeks = 1

* target population: at least 1 joint with synovitis not better explained by another disease

* a score >= 6 of 10 = definite rheumatoid arthritis

More general terms

• criteria

Additional terms

• rheumatoid arthritis (RA)