The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand

Authors

  • R. Altman MD,

    Corresponding author
    1. Miami Veterans Administration Medical Center and University of Miami School of Medicine, Miami, FL, and Chair, Subcommittee on Criteria for Osteoarthritis
    • American College of Rheumatology, 17 Executive Park Drive NE, Suite 480. Atlanta, GA 30329
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  • G. Alarcon MD,

    1. The University of Alabama at Birmingham
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • D. Appelrouth MD,

    1. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research), Atlanta, GA
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • D. Bloch PhD,

    1. Stanford University, Stanford, CA
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • D. Borenstein MD,

    1. George Washington University Medical Center, Washington, DC
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • K. Brandt MD,

    1. Indiana University School of Medicine, Indianapolis
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • C. Brown MD,

    1. Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • T. D. Cooke MD,

    1. Queen's University, Kingston, Ontario, Canada
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • W. Daniel MD,

    1. The University of Alabama at Birmingham
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • R. Gray MD,

    1. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research), Springfield, MA
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • R. Greenwald MD,

    1. Long Island Jewish Medical Center, New Hyde Park, NY
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • M. Hochberg MD, MPH,

    1. Johns Hopkins University, Baltimore, MD
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • D. Howell MD,

    1. University of Miami, Miami, FL
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • R. Ike MD,

    1. University of Michigan, Ann Arbor
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • P. Kapila MD,

    1. University of Miami, Miami, FL
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • D. Kaplan MD,

    1. Downstate Medical Center, Brooklyn, NY
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • W. Koopman MD,

    1. The University of Alabama at Birmingham
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • S. Longley MD,

    1. University of Florida, Gainesville
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • D. J. Mcshane MD,

    1. Stanford University, Stanford, CA
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • T. Medsger MD,

    1. University of Pittsburgh, Pittsburgh, PA
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • B. Michel MD,

    1. Rheumaklinik Universitätsspital, Zurich, Switzerland
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • W. Murphy MD,

    1. Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • T. Osial MD,

    1. University of Pittsburgh, Pittsburgh, PA
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • R. Ramsey-Goldman MD, MPH,

    1. University of Pittsburgh, Pittsburgh, PA
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • B. Rothschild MD,

    1. Arthritis Center of Northeast Ohio, Youngstown
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • K. Stark MD,

    1. Downstate Medical Center, Brooklyn, NY: F. Wolfe, MD: University of Kansas, Wichita
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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  • F. Wolfe MD

    1. University of Kanvas, Wichita
    2. American College of Rheumatology Subcommittee on Criteria for Osteoarthritis (Diagnostic and Therapeutic Criteria Committee of the Council on Research).
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Abstract

Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis (OA) of the hands were developed from data collected in a multi-center study. Patients with OA were compared with a group of patients who had hand symptoms from other causes, such as rheumatoid arthritis and the spondylar-thropathies. Variables from the medical history, physical examination, laboratory tests, and radiographs were analyzed. All patients had pain, aching, or stiffness in the hands. Patients were classified as having clinical OA if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints, swelling of fewer than 3 metacarpophalangeal joints, and hard tissue enlargement of at least 2 distal interphalangeal (DIP) joints. If the patient had fewer than 2 enlarged DIP joints, then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to OA. The 10 selected joints were the second and third DIP, the second and third proximal interphalangeal, and the trapeziometacarpal (base of the thumb) joints of both hands. Criteria derived using the “classification tree” method were 92% sensitive and 98% specific. The “traditional format” classification method required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand. The latter sensitivity was 94% and the specificity was 87%. Radiography was of less value than clinical examination in the classification of symptomatic OA of the hands.

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