2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative


Daniel Aletaha, Medical University of Vienna
Tuhina Neogi, Boston University
Alan J. Silman, Arthritis Research UK
Julia Funovits, Medical University of Vienna
David T. Felson, Boston University
Clifton O. Bingham III, Johns Hopkins University
Neal S. Birnbaum, University of California - San Francisco
Gerd R. Burmester, Humboldt University Berlin
Vivian P. Bykerk, University of Toronto,
Marc D. Cohen, National Jewish Medical and Research Center
Bernard Combe, Montpellier I University
Karen H. Costenbader, Harvard University
Maxime Dougados, Paris-Descartes University
Paul Emery, University of Leeds
Gianfranco Ferraccioli, Catholic University of the Sacred Heart
Johanna M. W. Hazes, University of Rotterdam
Kathryn Hobbs, University of Colorado School of Medicine
Tom W. J. Huizinga, Leiden University Medical Centre
Arthur Kavanaugh, University of California - San Diego
Jonathan Kay, University of Massachusetts Medical School WorcesterFollow
Tore K. Kvien, Diakonhjemmet Hospital
Timothy Laing, University of Michigan - Ann Arbor
Philip Mease, University of Washington - Seattle Campus
Henri A. Menard, McGill University
Larry W. Moreland, University of Pittsburgh
Raymond L. Naden, Ministry of Health
Theodore Pincus, New York University Hospital for Joint Diseases
Josef S. Smolen, Medical University of Vienna
Ewa Stanislawska-Biernat, Institute of Rheumatology
Deborah Symmons, University of Manchester
Paul P. Tak, University of Amsterdam
Katherine S. Upchurch, University of Massachusetts Medical School
Jiri Vencovsky, Institute of Rheumatology
Frederick Wolfe, University of Kansas Main Campus
Gillian Hawker, University of Toronto

UMMS Affiliation

Department of Medicine, Division of Rheumatology

Publication Date


Document Type



Acute-Phase Reaction; Algorithms; Arthritis, Rheumatoid; Early Diagnosis; Europe; Humans; International Cooperation; North America; Severity of Illness Index; Societies, Medical; Synovitis; Terminology as Topic; Time Factors


Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases


OBJECTIVE: The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA.

METHODS: A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease--this being the appropriate current paradigm underlying the disease construct "rheumatoid arthritis."

RESULTS: In the new criteria set, classification as "definite RA" is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0-5), serologic abnormality (score range 0-3), elevated acute-phase response (score range 0-1), and symptom duration (2 levels; range 0-1).

CONCLUSION: This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct "rheumatoid arthritis."

DOI of Published Version



Arthritis Rheum. 2010 Sep;62(9):2569-81. doi: 10.1002/art.27584. Link to article on publisher's site

Journal/Book/Conference Title

Arthritis and rheumatism


This article was published simultaneously in the September 2010 issue of Annals of the Rheumatic Diseases. PubMed id: 20699241

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Link to Article in PubMed

PubMed ID