New Classification Criteria for Rheumatoid Arthritis

Correspondence to Jung-Soo Song, M.D., Ph.D. Division of Rheumatology, Department of Internal Medicine, Chung-Ang University School of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 156-755, Korea Tel: +82-2-6299-1409, Fax: +82-2-825-7571, E-mail: drsong@cau.ac.kr Copyrightc 2014 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 류마티스관절염의 새로운 분류기준

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.
b 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.

c
Although 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.d 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 palacement into the highest category possible based on the pattern of joint involvement.
f "Small joints" refers to the metacarpophalangeal joints, proximal interphalangeal joints, second through fifth metatarsophalangeal joints, thumb interphalangeal joints, and wrists.g In this category, at least 1 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 joinsts not specifically listed elsewhere (e.g., temporomandibular, acromioclavicular, sternoclavicular, etc.).h Negative refers to IU vlaues that are less than or equal to upper limit of normal (ULN) for the laboratory and assay; low-positive reders 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.Where rheumatoid factor (RF) information is only available as positive or negative, a positive result should be scored as low-positive for RF.ACPA, anti-citrullinated protein antibody.

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joints (with or without involvement of large joints) f 10 small joints (with or without involvement or large joints) > 10 joints (at least 1 small joint) g B. Serology (at least 1 test result is needed for classification) h Negative RF and negative ACPA Low-positive RF or low-positive ACPA High-positive RF or high-positive ACPA C. Acute-phase reactants (at least 1 test result is needed for classification) i Normal CRP and normal ESR Abnormal CRP or abnormal ESR D. Duration of symptoms j

Table 2 .
The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis