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Cut out the attached list and paste it into your "pocket brain" for those times when patients or colleagues ask you what the criteria are for rheumatoid arthritis. The list below is adapted from the 1987 Criteria for the Classification of Acute Arthritis of Rheumatoid Arthritis. Feel free to add your favorite bits of information to the pocket brain column of Drug Utilization Review by sending your information to the editor at firstname.lastname@example.org.
• RA statistics:
— Rheumatoid arthritis affects 2.1 million Americans, mostly women
— Onset is usually in middle-age, but often occurs in the 20s and 30s
— 1.5 million women have rheumatoid arthritis compared to 600,000 men
• Criteria for rheumatoid arthritis:
— Morning stiffness — in and around the joints, lasting at least one hour before maximal improvement
— Arthritis of three or more joint areas — at least three joint areas simultaneously have had soft tissue swelling or fluid (not bony overgrowth alone) observed by a physician. The 14 possible areas are right or left PIP (proximal interphalangeal [PIP] joints of the hands), metacarpophalangeal (MCP), wrist, elbow, knee, ankle, and MTP joints.
— Arthritis of hand joints — At least one area swollen (as defined above) in a wrist, MCP, or PIP joint.
— Symmetric arthritis — Simultaneous involvement of the same joint areas (as defined in 2) on both sides of the body (bilateral involvement of PIPs, MCPs, or MTPs is acceptable without absolute symmetry).
— Rheumatoid nodules — Subcutaneous nodules, over bony prominences, or extensor surfaces, or in juxtaarticular regions, observed by a physician.
— Serum rheumatoid factor — Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in less than 5% of normal control subjects.
— Radiographic changes — Radiographic changes typical of rheumatoid arthritis on posteroanterior hand and wrist radiographs, which must include erosions or unequivocal bony decalcification localized in or most marked adjacent to the involved joints (osteoarthritis changes alone do not qualify).
— For classification purposes, a patient is said to have rheumatoid arthritis if he/she has satisfied at least four of these seven criteria. Criteria 1 through 4 must have been present for at least six weeks. Patients with two clinical diagnoses are not excluded. Designation as classic, definite, or probable rheumatoid arthritis is not to be made.
From: Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315—24.
For more information on rheumatoid arthritis, see www.rheumatology.org/research/classification/ra.html.