Rheumatoid Arthritis Redefined | Arthritis Information
As we have mentioned before the ACR and EULARS have been working on a better diagnostic critera for RA. The new ones were introduced at this weeks ACR meeting in Philadelpha
Joint Involvement
1 med-large joint (0 points)
2-10 med-lg joints (1 point)
1-3 small joints (2 points)
4-10 small joints (3 points)
>10 joints (at least one small joint) (5 points)
Serology
Neither RF or ACPA positive (0 points)
At least one test low positive titer (2 points)
At least one test high positive titer (3 points)
Duration of Synovitis
<6 weeks (0 points)
>6 weeks (1 point)
Acute Phase Reactants
Neither ESR nor CRP abnormal (0 points)
Abnormal CRP or abnormal ESR (1 point)
anything greater than 6 points will result in an RA diagnosis. ACPA is the anti-ccp test. Note that all radiographic evidence has been removed though it might still remain helpful in borderline cases. ALso removed from diagnosis is symmetry a subject of much debate around here. But remember that just because it has been removed from the diagnosis critera that it is still a hallmark of the disease. It just may take a bit to show up.
Don't expect this to change overnight it will take a while for all the DR's to complete the CMEs pertaining to the new stuff. The end result should be people receiving earlier diagnosis.
oops forgot to provide thelink
Im suprised more medical writers havent picked this up as it is a major major change..I guess it just isn't sexy enough
buckeye2009-10-20 10:05:15Thanks for this Buckeye. It is good information to know when you discuss progress with your RD.
I saw this! When my RA first flared, I had existing jaw and foot problems that are now obviously RA, but the only joint I had involved was my comically swollen wrist. I have since had a comically swollen jaw, and some other joints have participated, but in a less spectacular fashion that a doctor might not note...although I could see that my elbows were swollen, it was a matter of knowing what my before/after looked like.
I am RF and ANA negative, and had mildly elevated ESR and CRP (although CRP shot up WHILE I was on methotrexate...which didn't work for me).
Long story short...I would not have been treated except that I had an x-ray on my wrist that showed I had an erosion. This actually showed after I had been on methotrexate, luckily my RD decide to get me started on meds because my wrist was so ridiculously swollen. MTX and Arava didn't really help, but Humira has.
Sorry to ramble. Never get to stop by anymore, so I am making up for it before I have to pop out again....but I wouldn't have been approved for treatment by insurance (on Humira) without tiny erosion on my wrist, because mainly I just have jaw and one wrist that are super bad. I wouldn't have enough points! Oh and my jaw also showed erosions. Lord knows what I have but Humira works!
Whoops, I meant ACPA not ANA. But I'm also ANA negative!
I'm bumping this because I think this is something that anyone struggling with diagnosis should take back to their doctors
This is awesome....been waiting for this for a while.
Quesiton...by "joint involvement" are they referring to swelling, pain, both? Base of my right thumb has mild pain but no swelling. Even If I include it in my count, I'm getting a score of 4....still 2 points away from diagnosis.
Actually, there are several forms of inflammatory arthritis.
RA
PsA
Reactive Arthritis [Reiter's Syndrome]
Ankylosing Spondylitis
Enteropathic Arthritis
See this link for descriptions:
It's worth mentioning that many patients with RA come out negative on the RF test. When they do, assuming the physician feels relatively certain that the patient has RA, the test may be rerun again in the future. I have heard of some people who had the test run 3-4 times over a few years before they got a positive result. [And this could have been a false positive, which further complicates the matter.]
There is a relatively new test, the CCP3, which measures antibodies to cyclic citrullinated peptide, seen exclusively in patients with early stages of RA. It's valid 90-95% of the time, which is far better than the RA test when done in early diagnosis.
Note that people with PsA have also had positive results to this antibody test. In the end, it's probably not important to distinguish between RA and PsA because the treatment is essentially the same.
Sam12342009-11-01 20:47:30It's interesting in the Serology section that RF Factor is given the same weight as CCP. With the high specificity of CCP, figured it might as well be worth 5 points.
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