2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis (RA)

The 2010 ACR/EULAR RA Criteria is determined by summing the selected points:

1. Any swollen or tender joint on examination, which may be confirmed by synovitis on imaging. Excludes DIP joints, first CMC joints, and first MTP joints. 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. “Large joints” = shoulders, elbows, hips, knees, and ankles. “Small joints” = MCP joints, PIP joints, 2nd-5th MTP joints, thumb IP joints, and wrists.
2. Negative = IU values ≤ULN for the lab and assay; low-positive = IU values >ULN but ≤3x ULN; high-positive = IU values >3x. If RF reported only as positive or negative, positive result should be scored as low-positive for RF.
3. According to lab.
4. Duration = patient self-report of the duration of synovitis signs/symptoms (e.g. pain, swelling, tenderness) in joints clinically involved at the time of assessment, regardless of treatment status.

Interpretation:

Provides a standardized approach to diagnosing RA, allowing for prompt treatment with disease-modifying antirheumatic drugs (DMARDs).

• Use to evaluate suspected cases of rheumatoid arthritis (RA) in patients with inflammatory synovitis.
• Can be utilized in research or clinical trials to establish a uniform diagnostic standard for RA patients.

• These criteria were created to emphasize RA characteristics, particularly those that emerge early in the disease course and are associated with erosive and/or persistent disease.
• Other inflammatory diseases, like gout, lupus, or psoriatic arthritis, may mimic RA, potentially leading to misclassification.
• Keep in mind, many individuals with RA may not satisfy these criteria, particularly very early on in the course of the disease.

• This tool should be used as a guide in diagnosing RA alongside clinical judgment, diagnostics, and specialist consultation, particularly in borderline or atypical cases.
• Score ≥6 with synovitis in ≥1 joint and absence of an alternative diagnosis: 
  
  • Highly indicative of RA.
  • Refer to a rheumatologist for further management and possible initiation of DMARD therapy.
  • Regularly monitor disease activity and response to therapy.
• Score <6: 
  
  • Consider alternative diagnoses; further diagnostic workup (e.g., imaging, additional labs) may be warranted.
  • Closely monitor and reassess if the patient’s symptoms change or evolve.