Rheumatoid Arthritis – Diagnosis And Investigations

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The American College of Rheumatology (1988 revised) developed

the following criteria for the classification of rheumatoid arthritis.

1. Morning Stiffness: This occurs in and around the joints and

lasts at least 1 hour before maximal improvement.

2. Arthritis of 3 or more joint areas: At least 3 joint areas

simultaneously have soft tissue swelling or fluid (not bony

overgrowth) observed by a physician. The 14 possible areas are

right or left proximal interphalangeal (PIP),

metatarsophalangeal (MTP) joints.

3. Arthritis of hand joints of at least one area swollen in a wrist,

MCP, or PIP joint.

4. Symmetric arthritis with simultaneous involvement of the same

joint areas on both sides of the body. Bilateral involvement of

PIPs, MCPs, and MTPs is acceptable without absolute


5. Rheumatoid nodules: Subcutaneous nodules are present over

bony prominences or extensor surfaces or in juxta-articular


6. Serum Rheumatoid Factor: Abnormal amounts of serum RF

are demonstrated by any method for which the result has been

positive in fewer than 5% of healthy control subjects.

7. Radiographic changes typical of RA on posteroanterior hand

and wrist radiographs, which must include erosions or

unequivocal bony decalcification localized in or most marked

adjacent to the involved joints. Osteoarthritic changes alone do

not qualify.

A patient can be classified as having RA if 4 of 7 criteria are

present. Criteria 1- 4 must be present for at least 6 weeks, and a physician

must observe criteria 2 – 5. These criteria are intended as a guideline for

classification of patients, often for research purposes. They do not

absolutely confirm or exclude a diagnosis of RA in a particular patient,

especially in those with early arthritis.


No pathognomonic test is available to confirm the diagnosis of RA;

instead, the diagnosis is made using clinical, laboratory, and imaging


1. Haematological:


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