Rheumatoid arthritis diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Diagnostic Criteria
The American College of Rheumatology has defined (1987) the following criteria for the classification of rheumatoid arthritis:[1]
- Morning stiffness of >1 hour most mornings for at least 6 weeks.
- Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups, present for at least 6 weeks
- Arthritis of hand joints, present for at least 6 weeks
- Symmetric arthritis, present for at least 6 weeks
- Subcutaneous nodules in specific places
- Rheumatoid factor at a level above the 95th percentile
- Radiological changes suggestive of joint erosion
At least four criteria have to be met for classification as RA.
It is important to note that these criteria are not intended for the diagnosis of patients for routine clinical care. They were primarily intended to categorize patients for research. For example: one of the criteria is the presence of bone erosion on X-Ray. Prevention of bone erosion is one of the main aims of treatment because it is generally irreversible. To wait until all of the ACR criteria for rheumatoid arthritis are met may sometimes result in a worse outcome for the patient. Most patients and rheumatologists would agree that it would be better to treat the patient as early as possible and prevent bone erosion from occurring, even if this means treating patients who don't fulfill the ACR criteria. The ACR criteria are, however, very useful for categorising patients with established rheumatoid arthritis, for example for epidemiological purposes.
References
- ↑ Arnett F, Edworthy S, Bloch D, McShane D, Fries J, Cooper N, Healey L, Kaplan S, Liang M, Luthra H (1988). "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis". Arthritis Rheum. 31 (3): 315–24. PMID 3358796.