New Diagnostic Criteria

Change is in the wind.  Until now, the ACR’s diagnostic criteria for RA has been any four of the following:

  1. Morning stiffness, lasting for at least an hour, present daily for at least 6 weeks
  2. Arthritis of 3 or more joints, lasting for at least 6 weeks
  3. Arthritis of the hand joints, lasting for at least 6 weeks
  4. Symmetric arthritis, lasting for at least 6 weeks
  5. Rheumatoid nodules
  6. Positive rheumatoid factor (blood test)
  7. Joint changes on x-ray

Recently, the American College of Rheumatology collaborated with the European League Against Rheumatism to re-define diagnostic criteria.  Instead of needing to see evidence of long-term damage, the goal will be to treat RA aggressively enough that damage doesn’t occur. 

Now, instead of the aforementioned criteria, there is a scoresheet that looks at joint involvement, serology, duration of synovitis, and acute phase reactants:

Joint Involvement

  • 1 med-large joint (0 points)
  • 2-10 med-lg joints (1 point)
  • 1-3 small joints (2 points)
  • 4-10 small joints (3 points)
  • >10 joints (at least one small joint) (5 points)


  • Neither RF or ACPA positive (0 points)
  • At least one test low positive titer (2 points)
  • At least one test high positive titer (3 points)

Duration of Synovitis

  • <6 weeks (0 points)
  • >6 weeks (1 point)

Acute Phase Reactants

  • Neither ESR nor CRP abnormal (0 points)
  • Abnormal CRP or abnormal ESR (1 point)

Total score of six or more points means a definite RA diagnosis, even without x-ray evidence.  Doctors aren’t limited by normal sed rate, CRP, or RF.  A zillion joints involved for six or more weeks equates to a positive diagnosis without it mattering one bit what any lab results might say.

Patients can read more about it here.

ACPA = anti-cyclic citrullinated peptide antibody (ie, anti-CCP test)


5 thoughts on “New Diagnostic Criteria

    • Many do not have a positive RF. Whether it’s 20% or 35% or some other number doesn’t matter a whole lot. There are so many physicians who don’t realize there are other criteria. Somewhere along the line doctors without specialized training in rheumatology got the idea that a negative RF equates to the absence of RA. As you know, that’s just not true. This new scoresheet gives equal footing to the CCP test. There are now two options under serology. CCP is considered an early indicator; it can be positive a year prior to any symptoms, so acknowledgement of the value of this test is a huge step.

  1. Thanks for describing the criteria changes in a manner that is easy to understand. Hopefully more patients will be able to receive an earlier diagnosis and earlier treatment.

  2. I’m sending this to my internist and to my rheumy-doc. My rheumy-doc probably knows it already, but it’s good to let him know that his patients know it, too. My internist is very enlightened, and also *probably* knows this, but I’m gonna tell him anyway, too.

    Thanks for the simple explanation of these new criteria!

  3. Pingback: Questions « ∞ itis

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s