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Target population (Who should be tested?): Patients who
1. Have at least one joint with definite clinical synovitis (swelling)*
2. With the synovitis not better explained by another disease†
1. Have at least one joint with definite clinical synovitis (swelling)*
2. With the synovitis not better explained by another disease†
*The criteria are aimed at classification of newly presenting patients. In addition, patients with erosive disease typical of rheumatoid arthritis (RA) with a history compatible with prior fulfillment of the 2010 criteria should be classified as having RA. Patients with longstanding disease, including those whose disease is inactive (with or without treatment) who, based on retrospectively available data, have previously fulfilled the 2010 criteria should be classified as having RA.
†Differential diagnoses vary among patients with different presentations but may include conditions such as systemic lupus erythematosus, psoriatic arthritis, and gout. If it is unclear about the relevant differential diagnoses to consider, an expert rheumatologist should be consulted.
†Differential diagnoses vary among patients with different presentations but may include conditions such as systemic lupus erythematosus, psoriatic arthritis, and gout. If it is unclear about the relevant differential diagnoses to consider, an expert rheumatologist should be consulted.
| Classification criteria for RA (score-based algorithm: add score of categories A–D; a score of ≥6 of 10 is needed for classification of a patient as having definite RA)‡ | Score |
| A. Joint involvement§ | |
| 1 large joint∥ | 0 |
| 2–10 large joints | 1 |
| 1–3 small joints (with or without involvement of large joints)¶ | 2 |
| 4–10 small joints (with or without involvement of large joints) | 3 |
| >10 joints (at least 1 small joint)** | 5 |
| B. Serology (at least 1 test result is needed for classification)†† | |
| Negative RF and negative ACPA | 0 |
| Low-positive RF or low-positive ACPA | 2 |
| High-positive RF or high-positive ACPA | 3 |
| C. Acute-phase reactants (at least 1 test result is needed for classification)‡‡ | |
| Normal CRP and normal ESR | 0 |
| Abnormal CRP or abnormal ESR | 1 |
| D. Duration of symptoms§§ | |
| <6 weeks | 0 |
| ≥6 weeks | 1 |
| ‡Although patients with a score of 6 of 10 are not classifiable as having RA, their status can be reassessed, and the criteria might be fulfilled cumulatively over time. | |
| §Joint involvement refers to any swollen or tender joint on examination, which may be confirmed by imaging evidence of synovitis. Distal interphalangeal joints, first carpometacarpal joints, and first metatarsophalangeal joints are excluded from assessment. Categories of joint distribution are classified according to the location and number of involved joints, with placement into the highest category possible based on the pattern of joint involvement. | |
| ∥“Large joints” refers to shoulders, elbows, hips, knees, and ankles. | |
| ¶“Small joints” refers to the metacarpophalangeal joints, proximal interphalangeal joints, second through fifth metatarsophalangeal joints, thumb interphalangeal joints, and wrists. | |
| **In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large and additional small joints, as well as other joints not specifically listed elsewhere (e.g., temporomandibular, acromioclavicular, sternoclavicular). | |
| ††Negative refers to IU values that are less than or equal to the upper limit of normal (ULN) for the laboratory and assay; low-positive refers to IU values that are higher than the ULN but ≤3 times the ULN for the laboratory and assay; high-positive refers to IU values that are ≥3 times the ULN for the laboratory and assay. When rheumatoid factor (RF) information is only available as positive or negative, a positive result should be scored as low positive for RF. | |
| ‡‡Normal and abnormal are determined by local laboratory standards. | |
| §§Duration of symptoms refers to patient self-report of the duration of signs or symptoms of synovitis (e.g., pain, swelling, tenderness) of joints that are clinically involved at the time of assessment regardless of treatment status. |
Reference: Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative [published correction appears in Ann Rheum Dis. 2010 Oct;69(10):1892]. Ann Rheum Dis. 2010;69(9):1580-1588. [20699241]
For classification purposes, a patient has RA if at least four of these criteria are satisfied (the first four must have been present for at least six weeks).
| Criterion | Description |
|---|---|
| Morning stiffness | Morning stiffness in and around the joints, lasting at least one hour before maximal improvement. |
| Arthritis of three or more joint areas | At least three joint areas (out of 14 possible areas; right or left PIP, MCP, wrist, elbow, knee, ankle, MTP joints) simultaneously have had soft tissue swelling or fluid (not bony overgrowth alone) as observed by a physician. |
| Arthritis of hand joints | At least one area swollen (as defined above) in a wrist, MCP, or PIP joint. |
| Symmetric arthritis | Simultaneous involvement of the same joint areas (as defined above) on both sides of the body (bilateral involvement of PIPs, MCPs, or MTPs, without absolute symmetry is acceptable). |
| Rheumatoid nodules | Subcutaneous nodules over bony prominences or extensor surfaces, or in juxta-articular regions as observed by a physician. |
| Serum rheumatoid factor | Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in less than 5 percent of normal control subjects. |
| Radiographic changes | Radiographic changes typical of rheumatoid arthritis on posteroanterior hand or wrist radiographs, which must include erosions or unequivocal bony decalcification localised in, or most marked adjacent to, the involved joints (osteoarthritis changes alone do not qualify). |
Reference: Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-324. [3358796]
Last update: January 4, 2022