A. RHEUMATOID
ARTHRITIS.
ARNETT ET AL ARTH RHEUM 30:S17, 1987
1 MORNING STIFFNESS FOR AT LEAST ONE HOUR AND PRESENT FOR
AT LEAST SIX WEEKS.
2. SWELLING OF THREE OR MORE JOINTS FOR AT LEAST SIX WEEKS.
3. SWELLING OF WRIST,MCP OR PIP FOR SIX OR MORE WEEKS.
4. SYMMETRICAL JOINT SWELLING.
5. HAND XRAY CHANGES TYPICAL OF RA THAT MUST INCLUDE EROSIONS OR UNEQUIVOCAL BONY
DECALCIFICATION.
6. RHEUMATOID NODULES.
7. SERUM RHEUMATOID FACTOR BY A METHOD POSITIVE IN LESS THAN 5% OF NORMALS.
REQUIRE AT LEAST FOUR CRITERIA.
CRITERIA FOR CLINICAL REMISSION IN RHEUMATOID ARTHRITIS.
1. DURATION OF MORNING STIFFNESS NOT EXCEEDING 15 MINUTES.
2. NO FATIGUE.
3. NO SYMPTOMS OF JOINT PAIN.
4. NO JOINT TENDERNESS OR PAIN ON MOTION.
5. NO SOFT TISSUE SWELLING IN JOINTS OR TENDON SHEATHS.
6. ESR < 30 (FEMALE) AND <20 (MALE)
REQUIRE 5 OR MORE FOR AT LEAST 2 CONSECUTIVE MONTHS.
THERE MUST BE NO CLINICAL MANIFESTATION OF ACTIVE VASCULITIS, PERICARDITIS, PLEURITIS, OR
MYOSITIS OR UNEXPLAINED RECENT WEIGHT LOSS OR FEVER ATTRIBUTABLE TO RA.
CRITERIA FOR DETERMINATION OF PROGRESSION OF RA.
STAGE 1. EARLY. NO DESTRUCTIVE CHANGE ON X-RAYS.
OSTEOPOROSIS MAY BE PRESENT.
STAGE 2. MODERATE. XRAY EVIDENCE OF OSTEOPOROSIS +/- SLIGHT SUBCHONDRAL BONE DESTRUCTION.
SLIGHT CARTILAGE DAMAGE MAY BE PRESENT. NO JOINT DEFORMITY, ALTHOUGH LIMITATION OF JOINT
MOBILITY MAY BE PRESENT. ADJACENT MUSCLE ATROPHY. EXTRA ARTICULAR SOFT TISSUE LESIONS MAY
BE PRESENT INCLUDING NODULES AND TENOSYNOVITIS.
STAGE 3. XRAY CHANGES OF CARTILAGE AND BONE DESTRUCTION IN ADDITION TO OSTEOPOROSIS. JOINT
DEFORMITY, INCLUDING SUBLUXATION, ULNAR DEVIATION OR HYPER EXTENSION WITHOUT FIBROUS OR
BONY ANKYLOSIS. EXTENSIVE MUSCLE ATROPHY. EXTRA ARTICULAR SOFT TISSUE LESIONS MAY BE
PRESENT INCLUDING NODULES AND TENOSYNOVITIS.
STAGE 4. TERMINAL. FIBROUS OR BONY ANKYLOSIS. CRITERIA OF STAGE 3.
CLASSIFICATION OF FUNCTIONAL CAPACITY IN RHEUMATOID ARTHRITIS.
CLASS 1. COMPLETE. CAN DO ALL USUAL DUTIES WITHOUT
HANDICAP.
CLASS 2. CAN DO NORMAL ACTIVITIES DESPITE DISCOMFORT OR LIMITED MOBILITY OF ONE OR MORE
JOINTS. CLASS 3. CAN DO ONLY FEW OR NONE OF THE DUTIES OF USUAL OCCUPATION OR OF
SELF-CARE.
CLASS 4. LARGELY OR WHOLLY INCAPACITATED WITH PATIENT CONFINED TO BED OR CHAIR, PERMITTING
LITTLE OR NO SELF-CARE.
CRITERIA FOR DIAGNOSIS OF JUVENILE RHEUMATOID ARTHRITIS.
SUBDIVIDED INTO 3 SUB-TYPES:
1. SYSTEMIC.
2. POLYARTICULAR.
3. PAUCIARTICULAR.
A. GENERAL CRITERIA FOR DIAGNOSIS OF JRA.
1. PERSISTENT ARTHRITIS FOR AT LEAST 6 WEEKS IN ONE OR
MORE JOINTS.
2. EXCLUSION OF OTHER TYPES OF ARTHRITIS / OTHER RHEUMATIC DISEASE rheumatic fever
systemic lupus erythematosus Ankylosing spondylitis Polymyositis/dermatomyositis
vasculitis syndromes Scleroderma psoriatic arthritis Reiter's syndrome Sjogrens
syndrome
mixed connective tissue disease Behcets syndrome INFECTIOUS ARTHRITIS. INFLAMMATORY BOWEL
DISEASE. NEOPLASTIC DISEASES. NON RHEUMATIC DISEASES OF BONES AND JOINTS. HEMATOLOGICAL
DISEASES. PSYCHOGENIC ARTHRALGIA. MISCELLANEOUS Sarcoid hypertrophic osteoarthropathy
villonodular synovitis chronic active hepatitis familial Mediterranean fever
B. SYSTEMIC ONSET JRA.
JRA WITH PERSISTENT INTERMITTENT FEVER TO 103 degrees
FARENHEIGHT OR MORE, WITH OR WITHOUT RHEUMATOID RASH OR OTHER ORGAN INVOLVEMENT. TYPICAL
FEVER AND RASH WITHOUT ARTHRITIS MAY BE TERMED PROBABLE SYSTEMIC ONSET JRA.....
SUBTYPES:
polyarthritis
oligoarthritis
C. PAUCIARTICULAR JRA.
JRA WITH ARTHRITIS OF 4 OR FEWER JOINTS DURING THE FIRST
SIX MONTHS OF DISEASE......
SUBTYPES:
ANF +VE chronic uveitis
rheumatoid factor +ve
seronegative B27 +VE
not otherwise classified
D. POLYARTICULAR JRA.
JRA WITH ARTHRITIS OF 5 OR MORE JOINTS IN THE FIRST 6
MONTHS OF DISEASE
SUBTYPES:
rheumatoid factor +ve
not otherwise classified
REVISED CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS.
1. MALAR RASH. FIXED ERYTHEMA, FLAT OR RAISED OVER MALAR
EMINENCES, TENDING TO SPARE THE NASOLABIAL FOLDS.
2. DISCOID RASH. ERYTHEMATOUS RAISED PATCHES WITH ADHERENT KERATOTIC SCALING AND
FOLLICULAR PLUGGING. ATROPHIC SCARRING CAN OCCUR IN OLDER LESIONS.
3. PHOTOSENSITIVITY. SKIN RASH AS A RESULT OF UNUSUAL REACTION TO SUNLIGHT BY PATIENT
HISTORY OR CLINICAL OBSERVATION.
4. ORAL ULCERS. ORAL OR NASOPHARYNGEAL ULCERATION, USUALLY PAINLESS, OBSERVED BY PHYSICIAN.
5. ARTHRITIS. NON-EROSIVE ARTHRITIS INVOLVING 2 OR MORE PERIPHERAL JOINTS CHARACTERIZED
BY TENDERNESS, SWELLING OR EFFUSION.
6. SEROSITIS. PLEURITIS HISTORY/RUB/EFFUSION...OR..PERICARDITIS ECG/RUB/EFFUSION.
7. RENAL DISORDER. PERSISTENT PROTEINURIA >0,5g/DAY OR >3+ ..OR. CELLULAR CASTES
(RBC/HAEMOGLOBIN/GRANULAR/TUBULAR/MIXED).
8. NEUROLOGICAL DISORDER. SEIZURES, IN THE ABSENCE OF OFFENDING DRUGS OR KNOWN METABOLIC
DERANGEMENTS, i.e. UREMIA, KETOACIDOSIS, OR ELECTROLYTE IMBALANCE...OR PSYCHOSIS, IN THE
ABSENCE OF OFFENDING DRUGS OR KNOWN METABOLIC DERANGEMENTS, i.e. UREMIA, KETOACIDOSIS, OR
ELECTROLYTE IMBALANCE.
9. HEMATOLOGICAL DISORDER. HEMOLYTIC DISORDER WITH RETICULOCYTOSIS. LEUKOPENIA
<4000/mm3, ON 2 OR MORE OCCASIONS. LYMPHOPENIA <1500/mm3, ON 2 OR MORE
OCCASIONS. THROMBOCYTOPENIA <100000/mm3 IN THE ABSENCE OF OFFENDING DRUGS.
10. IMMUNOLOGIC DISORDER. POSITIVE LE PREPARATION. ANTI DNA. ANTI Sm NUCLEAR ANTIGEN.
FALSE POSITIVE TEST FOR SYPHILIS FOR AT LEAST SIX MONTHS, CONFIRMED BY TREPONEMA PALLIDUM
IMMOBILIZATION OR FLUORESCENT TREPONEMAL ANTIBODY ABSORPTION TEST.
11. ANTINUCLEAR ANTIBODY. ANTINUCLEAR ANTIBODY BY IMMUNOFLUORESCENCE OR EQUIVALENT ASSAY
IN THE ABSENCE OF DRUGS ASSOCIATED WITH DRUG INDUCED SLE.
REQUIRE 4 OR MORE CRITERIA FOR DIAGNOSIS, SERIALLY OR
SIMULTANEOUSLY.
JONES CRITERIA FOR THE DIAGNOSIS OF RHEUMATIC FEVER.
MAJOR |
MINOR. |
CARDITIS |
FEVER |
POLYARTHRITIS |
ARTHRALGIA |
CHOREA |
PREVIOUS RHEUM FEVER OR RHEUM HEART DISEASE |
ERYTHEMA MARGINATUM |
ACUTE PHASE REACTIONS: ESR/CRP/LEUKOCYTOSIS |
SUBCUT NODULES |
PROLONGED PR INTERVAL |
|
EVIDENCE OF STREP INFECTION :-
ASOT/STREP ANTIBODIES.
THROAT CULTURE GROUP A STREP.
RECENT SCARLET FEVER. |
REQUIRE: 2 MAJOR OR 1 MAJOR + 2 MINOR
CRITERIA FOR CLASSIFICATION OF SYSTEMIC SCLEROSIS (SCLERODERMA)
A. MAJOR CRITERION:
PROXIMAL SCLERODERMA:
SYMMETRICAL THICKENING, TIGHTENING, AND INDURATION OF THE SKIN OF THE FINGERS AND THE SKIN
PROXIMAL TO THE METACARPOPHALANGEAL OR METATARSOPHALANGEAL JOINTS. THE CHANGES MAY AFFECT
THE ENTIRE EXTREMITY, FACE, NECK AND TRUNK (THORAX AND ABDOMEN).
B. MINOR CRITERIA:
1. SCLERODACTYLY: SKIN CHANGES (AS ABOVE) LIMITED TO
THE FINGERS.
2. DIGITAL PITTING SCARS OR LOSS OF SUBSTANCE OF THE FINGER PAD.
3. BASILAR PULMONARY FIBROSIS.
REQUIRE THE ONE MAJOR, OR TWO MINOR FOR DIAGNOSIS.
CRITERIA FOR THE CLASSIFICATION OF ACUTE GOUTY ARTHRITIS.
A. PRESENCE OF CHARACTERISTIC URATE CRYSTALS IN THE JOINT
FLUID ..OR..
B. A TOPHUS PROVEN TO CONTAIN GOUTY CRYSTALS ..OR..
C. PRESENCE OF 6 OR MORE OF 12 CLINICAL/RADIOLOGICAL/LAB PHENOMENA :
1 > 1 attack.
2 maximal inflammation developed within 1 day.
3 attack of monoarticular arthritis.
4 joint redness observed.
5 1st MTP joint painful or swollen.
6 unilateral attack involving 1st MTP joint.
7 unilateral attack involving tarsal joint.
8 suspected tophus.
9 hyperuricaemia.
10 asymmetrical swelling within a joint (Xray).
11 subcortical cysts without erosions (Xray).
12 negative culture from joint fluid during attack.
CRITERIA FOR DIAGNOSIS OF POLYMYOSITIS AND
DERMATOMYOSITIS
BOHAN ET AL NEJM 292:342-347 1975
MAJOR CRITERIA
1. SYMMETRICAL WEAKNESS OF TE LIMB GIRDLE MUSCLES AND
ANTERIOR NECK FLEXORS, PROGRESSING OVER WEEKS OR MONTHS WITH OR WITHOUT DYSPHAGIA OR
RESPIRATORY MUSCLE INVOLVEMENT.
2. MUSCLE BIOPSY EVIDENCE OF NECROSIS OF TYPE 1 AND 2 FIBRES, PHAGOCYTOSIS, REGENERATION
WITH BASOPHILIA, LARGE VESICULAR SARCOLEMMAL NUCLEI AND PROMINENT NUCLEOLI, ATROPHY IN A
PERIFASCIAL DISTRIBUTION, VARIATION IN FIBER SIZE AND ANY INFLAMMATORY EXUDATE, OFTEN
PERIVASCULAR.
3. ELEVATED MUSCLE ENZYMES, ESPECIALLY CPK, ALDOLASE, LDH.
4. EMG TRIAD: SMALL POLYPHASIC ACTION POTENTIALS, POSITIVE SHARP WAVES AND INSERTIONAL
IRRITABILITY AND BIZARRE HIGH FREQUENCY REPETITIVE DISCHARGES.
5. DERMATOLOGICAL COMPONENT: HELIOTROPE WITH PERIORBITAL OEDEMA. A SCALY DERMATITIS OVER
DORSUM OF HANDS ESPECIALLY PIP'S (GOTTRONS SIGN), AND INVOLVEMENT OF KNEES, ELBOWS, MEDIAL
MALLEOLI, FACE AND UPPER TORSO.
DEFINITE :
DERMATOMYOSITIS: 3 OR 4 CRITERIA PLUS THE RASH.
POLYMYOSITIS : 4 CRITERIA WITHOUT RASH.
PROBABLE :
DERMATOMYOSITIS: 2 CRITERIA PLUS THE RASH.
POLYMYOSITIS : 3 CRITERIA WITHOUT RASH.
POSSIBLE :
DERMATOMYOSITIS: 1 CRITERIA PLUS THE RASH.
POLYMYOSITIS : 2 CRITERIA WITHOUT THE RASH.
CLASSIFICATION.
GROUP
1. PRIMARY IDIOPATHIC POLYMYOSITIS.
2. PRIMARY IDIOPATHIC DERMATOMYOSITIS.
3. ASSOCIATION WITH NEOPLASM.
4. CHILDHOOD TYPE ASSOCIATED WITH VASCULITIS.
5. ASSOCIATION WITH COLLAGEN VASCULAR DISEASE.
CRITERIA FOR MIXED CONNECTIVE TISSUE DISEASE.
SHARP ET AL: AM J MED 52:148-159 1972
SEROLOGICAL FINDINGS.
1. HIGH TITERS OF ENA.
2. MARKED SENSITIVITY OF THE ENA TO RIBONUCLEASE, MODERATE SENSITIVITY TO TRYPSIN, AND
RESISTANCE TO DNASE.
3. HIGH TITERS OF SPECKLED PATTERN ON FLUORESCENT ANTIBODY TEST.
4. NO DETECTABLE Sm ANTIBODY.
CLINICAL FINDINGS.
FEATURES SIMILAR TO SLE/SCLERODERMA/POLYMYOSITIS.
THE DIAGNOSTIC CRITERIA FOR ANKYLOSING SPONDYLITIS.
1. LIMITATION OF MOTION OF THE LUMBAR SPINE IN ALL THREE
PLANES: ANTERIOR FLEXION, LATERAL FLEXION, EXTENSION.
2. HISTORY OF PAIN IN THE LUMBAR SPINE OR AT THE DORSO-LUMBAR JUNCTION.
3. LIMITED CHEST EXPANSION TO 2,5 cm OR LESS, MEASURED AT THE FOURTH INTERCOSTAL LINE.
4. SACROILIITIS.
GRADE 0: NORMAL.
GRADE 1: SUSPICIOUS.
GRADE 2: MINIMAL ABNORMALITY, SMALL AREAS OF EROSIONS OR SCLEROSIS, WITHOUT ALTERATION OF
JOINT WIDTH.
GRADE 3: DEFINITE ABNORMALITY- MODERATE OR ADVANCED SACROILIITIS WITH IRREGULARITY, ONE OR
MORE EROSIONS, EVIDENCE OF SCLEROSIS. PARTIAL ANKYLOSIS
GRADE 4: TOTAL ANKYLOSIS.
DEFINITE ANKYLOSING SPONDYLITIS:
GRADE 3-4 SACROILIITIS WITH AT LEAST ONE CLINICAL
CRITERION. OR
GRADE 3-4 UNILATERAL OR
GRADE 2 BILATERAL SACROILIITIS, WITH CLINICAL CRITERION 1
OR CRITERION 2 AND 3.
PROBABLE ANKYLOSING SPONDYLITIS:
GRADE 3-4 SACROILIITIS WITHOUT ANY CLINICAL CRITERIA.
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