Rheumatoid arthritis classification
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There is no established system for the classification of rheumatoid arthritis. Depending on the presentation of rheumatoid arthritis, it is classified into typical classic rheumatoid arthritis and palindromic rheumatism. The classification criterion for the diagnosis of rheumatoid arthritis according to American College of Rheumatology, uses 4 parameters including joint involvement, serology, duration of symptoms, and acute phase reactants. If the score is more than 6 according to this criteria, the disease is classified as definite rheumatoid arthritis.
- Typical/classic rheumatoid arthritis:
- Palindromic rheumatism:
- The onset is episodic.
- Different joints are affected at different times or sequentially.
The 2010 American College of Rheumatology criteria rates various variables on a scale from 0-10 points. The points are assigned in four separate domains of signs and symptoms:
1) Joint involvement
3) Duration of symptoms
4) Acute phase reactants
Patients are classified as definite RA if the score of 6 or more points is seen according to the following criteria. The details of the scoring criteria are discussed below:
|The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis.|
|Joint Involvement||Median-large joint*||2-10||1|
|Serology||No positive for either RF or anti-CCP||0|
|At least one of these test positive at the high titer||2|
|At least one of these test positive at low titer||3|
|Duration of synovitis||+/> six weeks||1|
|Acute phase reactants||Neither CRP or ESR is abnormal||0|
|Abnormal CRP or ESR||1|
*Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment. Shoulder, elbow, knee, and ankle joints are included.
** Small joints refer to metacarpophalangeal, proximal interphalangeal, second through 5th metatarsophalangeal, thumb interphalangeal and wrist joints
*** In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large additional small joint joins as well as other such as temporomandibular, acromioclavicular, sternoclavicular
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