Rheumatoid arthritis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
There is no established system for the classification of rheumatoid arthritis. Depending on the presentation of rheumatoid arthritis, it is classified into typical classic rheumatoid arthritis and palindromic rheumatism. The classification criterion for the diagnosis of rheumatoid arthritis according to American College of Rheumatology, uses 4 parameters including joint involvement, serology, duration of symptoms, and acute phase reactants. If the score is more than 6 it is classified as definite rheumatoid arthritis.
Classification
There is no established system for the classification of rheumatoid arthritis. Depending on the presentation of rheumatoid arthritis, it may be classified as follows:
- Typical/classic rheumatoid arthritis:
- Disease onset is insidious and it involves early metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the fingers, the interphalangeal joints of the thumbs, the wrists, and the metatarsophalangeal (MTP) joints of the toes.[1][2]
- Palindromic rheumatism:
- The onset is episodic.
- Different joints are affected at different times or sequentially.
The 2010 American College of Rheumatology classification criteria for diagnosis of rheumatoid arthritis:[3][4]
The 2010 new criteria rates on a scale from 0-10 points are assigned in four separate domains of signs and symptoms:
1) Joint involvement
2) Serology
3) Duration of symptoms
4) Acute phase reactants
Patients are called as definite RA if there are the score of 6 or more points according to the following criteria
| The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis. | |||
|---|---|---|---|
| Domains | Description | Number | Score |
| Joint Involvement | Median-large joint* | ||
| 2-10 | 1 | ||
| 1-3 | 2 | ||
| Small joints@ | 4-10 | 3 | |
| >10~ | 5 | ||
| Serology | No positive for either RF or anti-CCP | 0 | |
| At least one of these test positive at the high titer | 2 | ||
| At least one of these test positive at low titer | 3 | ||
| Duration of synovitis | +/> six weeks | 1 | |
| Acute phase reactants | Neither CRP or ESR is abnormal | 0 | |
| Abnormal CRP or ESR | 1 | ||
*Shoulder, elbow, knee, ankle @ Small joints refer to metacarpophalangeal, proximal interphalangeal, second through 5th metatarsophalangeal, thumb interphalangeal and wrist joints ~ In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large additional small joint joins as well as other such as temporomandibular, acromioclavicular, sternoclavicular | |||
References
- ↑ Fleming A, Crown JM, Corbett M (August 1976). "Early rheumatoid disease. I. Onset". Ann. Rheum. Dis. 35 (4): 357–60. PMC 1007396. PMID 970994.
- ↑ Jacoby RK, Jayson MI, Cosh JA (April 1973). "Onset, early stages, and prognosis of rheumatoid arthritis: a clinical study of 100 patients with 11-year follow-up". Br Med J. 2 (5858): 96–100. PMC 1589106. PMID 4700332.
- ↑ Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (September 2010). "2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative". Arthritis Rheum. 62 (9): 2569–81. doi:10.1002/art.27584. PMID 20872595.
- ↑ Maksymowych WP, Suarez-Almazor ME, Buenviaje H, Cooper BL, Degeus C, Thompson M, Russell AS (November 2002). "HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis". J. Rheumatol. 29 (11): 2319–26. PMID 12415587.