Podiatry UK

The current criteria for the diagnosis of rheumatoid arthritis (RA) were developed in 1987. At its October meeting, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) released revised the guidelines. The revised criteria rate patients on a scale of 0-10 points, with points assigned in four separate domains of signs and symptoms: joint involvement, serology, duration of symptoms, and acute phase reactants. Those who tally 6 or more points are considered to have definite rheumatoid arthritis. The joint ACR/EULAR panel is still considering what score should distinguish patients with probable RA from those in whom RA is unlikely, but this cut point will probably be set at 3 or 4 points.

The guidelines are:

Patients are definitively diagnosed with RA if they score 6 or more points:

Domain: Joint involvement

– 1 medium-large joint (0 points)

– 2-10 medium-large joints (1 point)

– 1-3 small joints (2 points)

– 4-10 small joints (3 points)

– More than 10 small joints (5 points)

Domain: Serology

– Not positive for either rheumatoid factor or anti–citrullinated protein antibody (0 points)

– At least one of these two tests are positive at low titer, defined as more than the upper limit of normal but not higher than three times the upper limit of normal (2 points)

– At least one test is positive at high titer, defined as more than three times the upper limit of normal (3 points)

Domain: Duration of synovitis

– Less than 6 weeks (0 points)

– 6 weeks or longer (1 point)

Domain: Acute phase reactants

– Neither C-reactive protein nor erythrocyte sedimentation rate is abnormal (0 points)

– Abnormal CRP or abnormal ESR (1 point)