MDCalc

2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis (RA)

Classification criteria for rheumatoid arthritis (RA) by ACR/EULAR.

Use in patients who have at least one swollen joint and no better explanation for synovitis.

Joint involvement
Any swollen/tender joint on exam, excluding DIP joints and 1st MCP/MTP joints; select option that assigns the most possible points; see Evidence for details
Serology (need at least one serology test result to use these criteria)
Negative = IU values ≤ULN per lab/assay; low-positive = IU values >ULN but <3x ULN; high-positive = IU values ≥3x ULN; if RF reported only as positive or negative, positive result should be scored as low-positive; see Evidence for details
Acute-phase reactants (need at least one acute-phase reactant test result to use these criteria)
According to lab
Duration of symptoms
Duration = patient self-report of the duration of synovitis signs/symptoms (e.g. pain, swelling, tenderness) in joints clinically involved at the time of assessment, regardless of treatment status

Result:

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Advice
  • This tool should be used as a guide in diagnosing RA alongside clinical judgment, diagnostics, and specialist consultation, particularly in borderline or atypical cases.
  • Score ≥6 with synovitis in ≥1 joint and absence of an alternative diagnosis: 
    • Highly indicative of RA.
    • Refer to a rheumatologist for further management and possible initiation of DMARD therapy.
    • Regularly monitor disease activity and response to therapy.
  • Score <6: 
    • Consider alternative diagnoses; further diagnostic workup (e.g., imaging, additional labs) may be warranted.
    • Closely monitor and reassess if the patient’s symptoms change or evolve.
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