Rheumatoid arthritis (RA) is a systemic, chronic inflammatory disease that affects 0.5%-1% of the United States population.1,2 It is characterized by the swelling of synovial membrane tissue in the joints, morning stiffness lasting longer than an hour, and is typically a symmetrical polyarthritis.3 If untreated, it may lead to deformity through erosion of cartilage and bone and destruction of joints, resulting in pain and loss of physical function. Although RA typically affects joints, it can also have extra-articular manifestations, including rheumatoid nodules, lung scarring, vasculitis, coronary artery disease, and other systemic comorbidities.4 Patients with RA have an increased risk of developing cardiovascular disease, osteoporosis, cancer, and other chronic comorbidities compared to the general population. Besides clinical manifestations, there is also often a characteristic presence of rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) in serologic tests.5,6
There are two main classification criteria for RA. According to the 1987 Rheumatoid Arthritis Classification, a patient has RA if they have four of the following seven criteria: morning stiffness, arthritis of three or more joint areas, arthritis of hand joints, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor, or radiographic changes.7 The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA consists of a score-based algorithm that includes joint involvement (number of small or large joints affected), serology (RF and/or ACPA), C-reactive protein levels and/or erythrocyte sedimentation rate, and duration of symptoms.8 The goal of the 2010 criteria is to identify patients with early RA (within one year of symptom onset), which were not identified by the 1987 classification criteria.
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- Cush JJ, Kavanaugh A, Weinblatt ME. Rheumatoid arthritis: early diagnosis and treatment. Islip, NY: Professional Communications, Inc.; 2010.
- Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-2038.
- Aho K, Heliövaara M, Maatela J, Tuomi T, Palosuo T. Rheumatoid factors antedating clinical rheumatoid arthritis. J Rheumatol. 1991;18(9):1282-1284.
- Nielen MM, van Schaardenburg D, Reesink HW, et al. Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum. 2004;50(2):380-386.
- Arnett F, Edworthy S, Bloch D. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315-324.
- Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580-1588.