Appendix Table F-22010 rheumatoid arthritis criteria

Target population (Who should be tested?)
Patients who
  • have at least 1 joint with definite clinical synovitis (swelling)
    • Criteria aimed at classification of newly presenting patients; 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 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
  • with the synovitis not better explained by another disease


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
Classification criteria for RAScore
Score-based algorithm:
  • Add score of categories: Joint involvement, serology, reactants, duration
    • 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
  • Score of ≥6/10 needed for classification of a patient as having definite RA
    • 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
Joint involvement
Joint involvement refers to any swollen or tender joint on examination, which may be confirmed by imaging evidence of synovitis; d 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 placement into the highest category possible based on the pattern of joint involvement
 1 large joint0
  • “Large joints” refers to shoulders, elbows, hips, knees, and ankles
 2-10 large joints1
 1-3 small joints (with or without involvement of large joints)
  • “Small joints” refers to the metacarpophalangeal joints, proximal interphalangeal joints, second through fifth metatarsophalangeal joints, thumb interphalangeal joints, and wrists.
2
 4-10 small joints (with or without involvement of large joints)3
 >10 joints (at least 1 small joint)5
  • 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 joints not specifically listed elsewhere (e.g., temporomandibular, acromioclavicular, sternoclavicular, etc.)
Serology (at least 1 test result is needed for classification)††
  • Negative refers to IU values that are less than or equal to the upper limit of normal (ULN) for the laboratory and assay; low-positive refers 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
 Negative RF and negative ACPA0
 Low-positive RF or low-positive ACPA2
 High-positive RF or high-positive ACPA3
Acute-phase reactants (at least 1 test result is needed for classification)
  • Normal/abnormal is determined by local laboratory standards. CRp=C-reactive protein; ESR = erythrocyte sedimentation rate
 Normal CRP and normal ESR0
 Abnormal CRP or abnormal ESR1
Duration of symptoms
  • Duration of symptoms refers to patient self-report of the duration of signs or symptoms of synovitis (e.g., pain, swelling, tenderness) of joints that are clinically involved at the time of assessment, regardless of treatment status
 <6 weeks0
 ≥6 weeks1

Adapted from: 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatism. 2010 Sep; 62(9): 2569–2581204

From: Appendix F, Eligible Clinical and Self-Reported Scales and Instruments Commonly Used in Eligible Studies of Drug Therapy for Rheumatoid Arthritis

Cover of Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update
Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 211.
Donahue KE, Gartlehner G, Schulman ER, et al.
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