2010 ACR/EULAR rheumatoid arthritis classification criteria
Classifies newly presenting synovitis as definite RA (≥ 6/10 points)
- ACR/EULAR 2010
Sources last checked: 2026-10-13
2010 ACR/EULAR rheumatoid arthritis classification criteria
Classifies newly presenting synovitis as definite RA (≥ 6/10 points)
Classification criteria for studies, not diagnostic criteria. Patients with erosive disease typical of RA and a history compatible with prior fulfilment are classified as RA regardless of the current score. At least one serology and one acute-phase test are needed.
Interpretation
| Criteria not applicable | Without definite synovitis unexplained by another disease, the 2010 criteria should not be applied. |
|---|---|
| Not classified as RA (< 6/10) | Does not fulfil the criteria now; status can be reassessed — the criteria may be fulfilled cumulatively over time. |
| Classified as definite RA (≥ 6/10) | Fulfils the 2010 ACR/EULAR classification criteria. |
What is the 2010 ACR/EULAR rheumatoid arthritis classification criteria?
The 2010 ACR/EULAR criteria classify rheumatoid arthritis in patients with at least one joint with definite synovitis not better explained by another disease. Points from four domains — joint involvement, serology, acute-phase reactants and symptom duration — add up to a maximum of 10, and 6 or more classifies definite RA. They were developed jointly by the American College of Rheumatology and EULAR to capture RA earlier than the 1987 criteria.
When to use it
- In newly presenting inflammatory arthritis to classify RA for studies, registries and documentation
- To structure the early-arthritis assessment
- When reassessing a patient over time, since the criteria may be fulfilled cumulatively
When not to use it
- As a diagnostic rule for an individual patient — diagnosis remains a clinical judgement
- When the synovitis is better explained by another disease (e.g. SLE, psoriatic arthritis, gout)
How it is calculated
Applies only to patients with ≥ 1 swollen joint not better explained by another disease. A joints: 1 large 0 · 2–10 large 1 · 1–3 small 2 · 4–10 small 3 · > 10 (≥ 1 small) 5 B serology: negative 0 · low-positive RF/ACPA 2 · high-positive RF/ACPA 3 C acute-phase reactants: normal CRP and ESR 0 · abnormal CRP or ESR 1 D symptom duration: < 6 weeks 0 · ≥ 6 weeks 1 Total ≥ 6 of 10 = definite RA.
Clinical pearls and limitations
- Classification criteria for studies, not diagnostic criteria. Patients with erosive disease typical of RA and a history compatible with prior fulfilment are classified as RA regardless of the current score. At least one serology and one acute-phase test are needed.
- DIP, first CMC and first MTP joints do not count — they are typical of osteoarthritis.
- Place the patient in the highest joint category their pattern allows.
- Low-positive is above the upper limit of normal but no more than 3× ULN; high-positive is above 3× ULN.
- Typical RA erosions with a compatible history classify RA without scoring.
Frequently asked questions
How many points are needed for RA?
6 of 10.
Can a seronegative patient meet the 2010 criteria?
Yes, with > 10 joints (5 points) plus abnormal CRP/ESR and symptoms ≥ 6 weeks (5 + 1 + 1 = 7).
Are the 2010 criteria diagnostic criteria?
No — they are classification criteria intended to define homogeneous groups, although they are widely used to support early diagnosis.
Evidence and guidelines
- Primary source: 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 (simultaneously Arthritis Rheum 2010;62(9):2569-2581).
- American College of Rheumatology — 2010 RA classification criteria, complete article (Table 3).
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