“The sensitivity of the 2010 ACR diagnostic criteria for rheumatoid arthritis is roughly 80% to 85%, so there are often patients with features of who do not initially meet classification criteria,” Dr Miller observed. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.“Inflammatory arthritis is typically a clinical diagnosis, often associated with prolonged morning stiffness and improvement with use, warm temperature, and nonsteroidal anti-inflammatory drugs (NSAIDs),” John Miller, MD, a rheumatology specialist at Johns Hopkins Hospital and instructor of medicine at the Johns Hopkins University School of Medicine, Baltimore, Maryland, told Rheumatology Advisor. “Synovitis on exam may be overt, although with studies involving MRI and ultrasound, we also know that synovitis may not be detected on exam.”īecause the signs are nonspecific, UA is generally a diagnosis of exclusion until criteria for RA can be met. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. Criteria 1 through 4 must have been present for at least 6 weeks. The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints 4) symmetric swelling (arthritis) 5) rheumatoid nodules 6) the presence of rheumatoid factor and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA).
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