The american rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis

Frank C. Arnett, Steven M. Edworthy, Daniel A. Bloch, Dennis J. Mcshane, James F. Fries, Norman S. Cooper, Louis A. Healey, Stephen R. Kaplan, Matthew H. Liang, Harvinder S. Luthra, Thomas A. Medsger, Donald M. Mitchell, David H. Neustadt, Robert S. Pinals, Jane G. Schaller, John T. Sharp, Ronald L. Wilder, Gene G. Hunder

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). 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. Criteria 1 through 4 must have been present for at least 6 weeks. 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. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.