Rheumatoid Arthritis Criteria Mnemonics

The 2 commonly used criteria for diagnosis of rheumatoid arthritis will be discussed here.

1987 ACR Criteria

Mnemonic: DMARDs if MADRAS

1. Morning stiffness (>1 hour)
2. Arthritis in >/= 3 joint areas
3. Duration >6 weeks (of morning stiffness and other 3 features involving arthritis)
4. Rheumatoid nodules
5. Rheumatoid factor
6. Radiographic changes (erosions)
7. Arthritis of hand joints (>/= 1 swollen joint)
8. Symmetrical arthritis

Mnemonic: EARS

1. Early morning stiffness
2. Arthritis >/= 3 joints, hands involved
3. Rheumatoid factor, Rheumatoid nodules, Radiographic changes
4. Symmetrical arthritis, Six weeks

For diagnosis of RA: 4 out of 7 criteria must be present (except duration) and criteria listed above in number 1, 2, 7 and 8 must be present for >6 weeks to be established as criteria for RA.

Established RA: Sensitivity 79-80% and Specificity 90-93%

Early RA: Sensitivity 77-80% and Specificity 33-77%

2010 ACR/EULAR Criteria

Mnemonic: Three “A” and Two “6”

a. Arthritis (Joint involvement)

Large joints have smaller points and odd numbers of joint involvement get even numbered points.

1. 1 Large joint: 0
2. 2-10 Large joints: 1
3. 1-3 Small joints: 2
4. 4-10 Small joints: 3
5. >10 Joints (atleast 1 small joint): 5

b. Autoantibodies (RF and ACPA)

1. Both negative: 0
2. Any one is low positive: 2
3. Any one is high positive: 3

A weakly positive RF is defined as up to 3-fold higher and a strongly positive RF 3-fold higher than the upper normal range.

c. Acute phase reactants (CRP and ESR)

1. Both normal: 0
2. Any one is abnormal: 1

d. 6 weeks duation

1. <6 weeks duration: 0
2. >6 weeks duration: 1

e. >6/10 points = Definite RA

2010 Criteria increased the sensitivity for finding patients with early-stage disease who were destined eventually to develop full-blown RA over the next 6 years to 86% sensitivity, compared with 78% sensitivity for the 1987 criteria.