Chapter 66 - Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, Adult-Onset Still Disease, and Rheumatic Fever Flashcards
TABLE 66-1
2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Arthritis
Target population (2)
Target population: patients who
(a) have at least 1 joint with de nite clinical synovitis (swelling),
(b) with the synovitis not better explained by another disease.
TABLE 66-1
2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Arthritis
Score needed for definite RA classification
CLASSIFICATION CRITERIA FOR RHEUMATOID ARTHRITIS (RA) (ADD SCORE OF CATEGORIES A TO D; SCORE ≥6/10 IS NEEDED FOR DEFINITE RA CLASSIFICATION)
TABLE 66-1
2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Arthritis
Score
A. Joint Involvement: tender or swollen joint on examination, excluding distal IP joints, first MCP joints, and first MTP joints
- 1 large joint (shoulder, elbow, hip, knee, or ankle)
- 2 to 10 large joints
- 1 to 3 small joints (MCP, proximal IP, 2nd to 5th MTP, thumb IP, wrists) with or without large joints
- 4-10 small joints with or without large joints
- >10 joints (must have at least 1 small joint; other joints can include joints not specifically listed elsewhere, eg, TM, AC, SC)
0
1
2
3
5
TABLE 66-1
2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Arthritis
Score
B. Serology (at least 1 test result is needed for classification)
- Negative RF and negative ACPA
- Low-positive RF or low-positive ACPA
- High-positive RF or high-positive ACPA
0
2
3
TABLE 66-1
2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Arthritis
Score
C. Acute-phase reactants (at least 1 result needed for classification)
- Normal CRP and normal ESR
- Abnormal CRP or abnormal ESR
0
1
TABLE 66-1
2010 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Arthritis
Score
D. Duration of symptoms
(Patient self-report of the duration of signs or symptoms of synovitis (eg, pain, swelling, tenderness) of joints that are clinically involved at the time of assessment, regardless of treatment status)
- <6 weeks
- ≥6 weeks
0
1
TABLE 66-6
Diagnosis of Acute Rheumatic Fever in Patient Populations with Evidence of Preceding Group A Streptococcal Infection Using the 2015 Revised Jones Criteria
Diagnosis of initial acute rheumatic fever:
__ major criteria or
__ major plus __ minor criteria
Diagnosis of initial acute rheumatic fever:
2 major criteria or
1 major plus 2 minor criteria
TABLE 66-6
Diagnosis of Acute Rheumatic Fever in Patient Populations with Evidence of Preceding Group A Streptococcal Infection Using the 2015 Revised Jones Criteria
Diagnosis of recurrent acute rheumatic fever:
__ major criteria or
__ major plus __ or __ minor criteria
Diagnosis of recurrent acute rheumatic fever:
2 major criteria or
1 major plus 2 or 3 minor criteria
TABLE 66-6
Diagnosis of Acute Rheumatic Fever in Patient Populations with Evidence of Preceding Group A Streptococcal Infection Using the 2015 Revised Jones Criteria
MAJOR CRITERIA (5)
- Carditis: clinical and/or subclinical
- Chorea
- Erythema marginatum
- Subcutaneous nodules
- Arthritis:
- Polyarthritis only in low risk population
- Monoarthritis or polyarthritis or polyarthralgia in moderate risk and high risk populations
TABLE 66-6
Diagnosis of Acute Rheumatic Fever in Patient Populations with Evidence of Preceding Group A Streptococcal Infection Using the 2015 Revised Jones Criteria
MINOR CRITERIA (4)
- ECG abnormality: prolonged PR interval, after accounting for age variability
- Laboratory values:
- CRP ≥3.0 mg/dL and/or ESR ≥60 mm/h in low risk population
- CRP ≥3.0 mg/dL and/or ESR ≥30 mm/h in moderate risk and high risk populations - Fever:
- ≥38.5°C (101.3°F) in low risk population
- ≥38°C (100.4°F) in moderate risk and high risk populations - Arthritis:
- Polyarthralgia in low risk population
- Monoarthralgia in moderate risk and high risk populations
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Subcutaneous nodule over pressure points (olecranon, extensor forearm, Achilles tendon)
Rheumatoid nodule
(Rheumatoid Arthritis)
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Purpura, livedo reticularis, atrophie blanche, ulcers
Rheumatoid vasculitis
(Rheumatoid Arthritis)
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Deep, liquefying ulcers with a purple, undermined border, commonly affecting the lower extremities and abdomen
Pyoderma gangrenosum
(Rheumatoid Arthritis)
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Transient, salmon pink macular eruption coincident with febrile episodes
Classic cutaneous presentation
(Juvenile Idiopathic Arthritis)
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Transient, discrete, pink to red macules or edematous papules distributed over the chest, abdomen, and extensor arms, peaking with febrile episodes
Classic cutaneous presentation
(Adult-Onset Still Disease)
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Persistent pruritic papules and plaques with or without a ne scale, distributed over trunk, extremities, head, or neck; Koebner phenomenon may occur
Atypical cutaneous presentation
(Adult-Onset Still Disease)
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Evanescent, erythematous patches in annular or serpiginous configuration distributed over the torso, upper arms, and legs with facial sparing
Erythema marginatum
(Rheumatic Fever)
TABLE 66-7
Summary of Common Dermatologic Findings and Associations
DERMATOLOGIC FINDING
Firm, painless, and mobile nodules localizing over extensor surfaces (elbows, wrists, knees), and often associated with carditis
Subcutaneous nodules
(Rheumatic Fever)
