2010 American College of Rheumatology European League Against Rheumatism criteria for the classification of Rheumatoid Arthritis
With the knowledge that early effective treatment in RA improves long-term outcomes, the 2010 ACR/EULAR classification criteria for RA were designed to identify individuals with RA at an earlier stage of disease compared with the 1987 ACR RA classification criteria. The criteria demonstrate 82% sensitivity and 61% specificity for RA when compared with control subjects with non-RA rheumatic disease. While these criteria can be a guide, the purpose of classification is to define a homogenous population for study purposes. Ultimately, the diagnosis of RA is established by the rheumatologist.
The 2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Rheumatoid Arthritis
From Aletaha D, Neogi T, Silman AJ et al: 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69:1580–1588.
|1. Joint involvement (swollen or tender joint on examination)||(0–5 points max)|
|• One medium to large joint (shoulders, elbows, hips, knees, ankles)||0|
|• 2–10 medium to large joints||1|
|• 1–3 small joints (MCP, PIP, 2–5 MTP, or wrist with or without large joint involvement)||2|
|• 4–10 small joints (with or without large joint involvement)||3|
|• >10 joints (at least one small joint involved)||5|
|2. Serology||(0–3 points max)|
|• Negative RF and negative ACPA||0|
|• Low positive RF or low positive ACPA (<=3 times the normal upper limit)||2|
|• High positive RF or high positive ACPA (>3 times the normal upper limit)||3|
|3. Acute-phase reactants||(0–1 point max)|
|• Normal CRP and normal ESR||0|
|• Abnormal CRP or abnormal ESR||1|
|4. Duration of symptoms||(0–1 point max)|
|• <6 weeks||0|
|• ≥6 weeks||1|
To apply these criteria, the patient must have at least one joint swollen with inflammatory arthritis on clinical examination that is not explained by another disease. Magnetic resonance imaging/ultrasound may be used to confirm clinical findings.ACPA , anticitrullinated protein antibody; CRP , C-reactive protein; ESR , erythrocyte sedimentation rate; MCP , metacarpophalangeal joint; MTP , metatarsophalangeal joint; PIP , proximal interphalangeal joint; RF , rheumatoid factor.