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

Authors

  • Frank C. Arnett MD,

    Corresponding author
    1. Professor of Internal Medicine, The University of Texas Health Science Center at Houston
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
    • requests to the American Rheumatism Association, 17 Executive Park Drive, NE, Suite 480, Atlanta, GA 30329
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  • Steven M. Edworthy MD,

    1. Fellow of Immunology, Stanford University School of Medicine, Stanford, CA
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Daniel A. Bloch PhD,

    1. Senior Research Associate of Biostatistics in Immunology, Stanford University School of Medicine
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Dennis J. Mcshane MD,

    1. Assistant Professor of Immunology, Stanford University School of Medicine
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • James F. Fries MD,

    1. James F. Fries, MD: Associate Professor of Medicine, Stanford University School of Medicine
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Norman S. Cooper MD,

    1. Professor of Pathology, New York University School of Medicine, New York, NY
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Louis A. Healey MD,

    1. Virginia Mason Clinic, Seattle, WA
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Stephen R. Kaplan MD,

    1. Professor of Medicine, Brown University Program in Medicine, Providence, RI
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Matthew H. Liang MD MPH,

    1. Associate Professor of Medicine, Harvard Medical School, Boston, MA
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Harvinder S. Luthra MD,

    1. Associate Professor of Medicine, Mayo Medical School and Clinic, Rochester, MN
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Thomas A. Medsger Jr MD,

    1. Professor of Medicine, University of Pittsburgh, Pittsburgh, PA
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Donald M. Mitchell MD,

    1. Professor of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • David H. Neustadt MD,

    1. Clinical Professor of Medicine, University of Louisville School of Medicine, Louisville, KY
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Robert S. Pinals MD,

    1. Professor of Medicine, UMDNJ-Robert Wood Johnson Medical School, Newark, NJ, and The Medical Center at Princeton, Princeton, NJ
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Jane G. Schaller MD,

    1. Professor of Pediatrics, Tufts-New England Medical Center, Boston, MA
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • John T. Sharp MD,

    1. Staff Physician, Tifton Medical Clinic, Tifton, GA
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Ronald L. Wilder MD PhD,

    1. Senior Investigator, National Institute of Arthritis and Musculoskeletal and Skin Diseases
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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  • Gene G. Hunder MD

    1. Professor of Medicine, Mayo Medical School and Clinic.
    2. From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
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Abstract

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.

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