The 2010 ACR - EULAR Classification Criteria for Rheumatoid Arthritis

I'm sure many would have known of the ACR-EULAR criteria for Rheumatoid Arthritis as of 2010. (below)

Here is some pointer of what to take note of before someone overexcitedly applies the criteria everywhere.

1. There must be at least one joint with definite clinical synovitis. It is stated in the criteria but often overlooked, even by young doctors/ Masters students. Hence, you don't simply overuse ultrasound to diagnose synovitis unless you're unsure of your clinical skills (which I had doubts of you being able to interpret the ultrasound by then)
2. This is a new case of possible RA. Previously treated RA will stay as RA, hence you can't use this criteria to undiagnose patients with RA.
3. Other causes of synovitis has been ruled out(not caused by other disease, such as infective synovitis, etc.

Essentially, the 4 criterias used are:

• Joints Involved, the types (Large/Small) and number: (0-5)
• Serology (Low-positive/High-positive/Negative) of rheumatoid factor/ anti-citrulinated peptide antibody (0-3)
• Acute Phase Reactants (Normal/ Abnormal ) ESR/ CRP (0-1)
• Duration of Symptoms (More / Less than 6 Weeks) : (0-1)

A score of 6/10 or more identifies patients with rheumatoid arthritis, but a score of less than 6 does not rule out rheumatoid arthritis. Hence, reassessment can be done as appropriate as the score may be cumulatively fulfilled over time.

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