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Table 3 The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis

From: Giant cell arteritis with cervical radiculopathy mimicking polymyalgia rheumatica and elderly-onset rheumatoid arthritis: a case report

 

Score

Target population (who should be tested?): patients who

 

 1) have at least one joint with definite clinical synovitis (swelling)a

 

 2) have synovitis that is not attributable to another diseaseb

 Classification criteria for RA (score-based algorithm: add the scores in categories A–D; a score of ≥ 6/10 is needed for the classification of a patient as having definite RA)c

(A) Joint involvementd

 1 large jointe

0

 2−10 large joints

1

 1−3 small joints (with or without involvement of large joints)f

2

 4−10 small joints (with or without involvement of large joints)

3

 > 10 joints (at least one small joint)g

5

(B) Serology (at least one test result is needed for classification)h

 Negative RF and ACPA

0

 Low-positive RF or ACPA

2

 High-positive RF or ACPA

3

(C) Acute-phase reactants (at least one test result is needed for classification)i

 Normal CRP level and ESR

0

 Abnormal CRP level or normal ESR

1

(D) Duration of symptomsj

 < 6 weeks

0

 ≥ 6 weeks

1

  1. aThe criteria are established for the classification of patients newly presenting with symptoms. In addition, patients with erosive disease typical of RA with a history compatible with prior fulfillment of the 2010 criteria should be classified as having RA. Patients with long-standing disease, including those whose disease is inactive (with or without treatment), and who, based on retrospectively available data, have previously fulfilled the 2010 criteria should be classified as having RA
  2. bDifferential diagnoses differ in patients with different presentations but may include conditions such as systemic lupus erythematosus, psoriatic arthritis, and gout. If the relevant differential diagnoses to consider are unclear, an expert rheumatologist should be consulted
  3. cAlthough patients with a score of < 6/10 are not classifiable as having RA, their status can be reassessed, and the criteria might be fulfilled cumulatively over time
  4. dJoint involvement refers to any swollen or tender joint on examination, which may be confirmed by imaging evidence of synovitis. The distal interphalangeal, first carpometacarpal, and first metatarsophalangeal joints are excluded from the 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
  5. e“Large joints” refers to the shoulders, elbows, hips, knees, and ankles
  6. f“Small joints” refers to the metacarpophalangeal, proximal interphalangeal, second to fifth metatarsophalangeal, and thumb interphalangeal joints, as well as the wrists
  7. gIn 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 and other joints not specifically listed elsewhere (for example, temporomandibular, acromioclavicular, and sternoclavicular)
  8. h“negative” refers to international unit values that are less than or equal to the upper limit of normal for the laboratory test and assay; “low-positive” refers to international unit values that are higher than the limit of normal but ≤ 3 times the limit of normal for the laboratory test and assay; and “high-positive” refers to international unit values that are more than three times the limit of normal for the laboratory test and assay. When RF information is only available as “positive” or “negative,” a “positive” result should be scored as “low-positive” for RF
  9. iNormal/abnormal is determined on the basis of local laboratory standards
  10. j“Duration of symptoms” refers to patients’ self-report of the duration of signs or symptoms of synovitis (for example, pain, swelling, and tenderness) of the joints that are clinically involved at the time of assessment, regardless of the treatment status
  11. RA, rheumatoid arthritis; RF, rheumatoid factor; ACPA, anti-citrullinated protein antibody; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate
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Journal of Medical Case Reports

ISSN: 1752-1947