Rheumatoid arthritis diagnostic study of choice
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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
Anti-CCP antibodies testing is the gold standard test for the diagnosis of rheumatoid arthritis. It has the specificity of about 81-100%, with the sensitivity of 39–94%.
Diagnostic Study of Choice
- Anti-CCP antibodies testing is the gold standard test for the diagnosis of rheumatoid arthritis.[1][2]
- It has the specificity of about 81-100%, with the sensitivity of 39–94%.
Diagnostic Criteria
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 defined as having 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 | ||
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*Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment. *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. Joints such as temporomandibular, acromioclavicular, and sternoclavicular joints may also be involved. | |||
References
- ↑ van Venrooij WJ, Hazes JM, Visser H (November 2002). "Anticitrullinated protein/peptide antibody and its role in the diagnosis and prognosis of early rheumatoid arthritis". Neth J Med. 60 (10): 383–8. PMID 12607587.
- ↑ Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC, van Venrooij WJ (January 2000). "The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide". Arthritis Rheum. 43 (1): 155–63. doi:10.1002/1529-0131(200001)43:1<155::AID-ANR20>3.0.CO;2-3. PMID 10643712.
- ↑ 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.