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diagnostic criteria for rheumatoid arthritis (RA)
1987 Revised criteria: (any 4 of 7 make the diagnosis of RA)*
1) morning stiffness (at least 1 hr)
2) 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]
3) arthritis of hand or wrist joints [i.e. synovitis in wrist, MCP, or PIP]
4) symmetric arthritis [i.e. simultaneous involvement of the same joint bilaterally, involving at least 2 different areas].
5) rheumatoid nodules
6) serum rheumatoid factor
7) 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 [1]
1) 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
2) serology (at least 1 test result needed for classification)
a) negative RF & negative anti-CCP Ab
b) low positive RF or low positive anti-CCP Ab = 2
- level 1-3 times upper limit of reference interval
c) high positive RF or high positive anti-CCP Ab = 3
- level >3 times upper limit of reference interval
3) 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
4) 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
Related
rheumatoid arthritis (RA)
General
criteria
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17.
American College of Physicians, Philadelphia 1998, 2015