The course of RA is unique to each of us. My RA announced itself to me as big and boisterous. Initially, I had sharp pain in my left shoulder. I thought it was from swimming as shoulders do get a workout in lap swimming. Quickly hands, fingers, wrists, ankles, feet and toes joined in. I was in total pain and largely incapacitated. I sought salvation to my problem in the ER, the only solution at the time.
In 2010 the American College of Rheumatology(ACR) and the European League Against Rheumatism(EULAR) formed a working group to replace the 1987 ACR classification criteria for RA with up to date classification criteria.
RA is at its most destructive in the first 2 years. It needs to be caught early and treated aggressively. The 2010 Rheumatoid Arthritis Classification Criteria became a big diagnostic help.
The group came up with a 10 point system that covers four RA categories: joint involvement, serology, acute-phase reactants, duration of symptoms. The target population for this scoring must be patients who have at least 1 joint with definite clinical synovitis(swelling) that cannot be explained by another disease.
There could be a total of 10 points. 6 points would confirm the RA diagnosis.
A. Joint involvement Points
1. One large joint 0 2. 2-10 large joints 1 3. 1-3 small joints 2 4. 4-10 small joints 3 5. > 10 joints( at least one small joint) 5
1. Negative RF and negative ACPA 0 2. Low positive RF or low positive ACPA 2 3. High positive RF or high positive ACPA 3
C. Acute-phase reactants
1. Normal CRP and normal ESR 0 2. Abnormal CRP or abnormal ESR 1
D. Duration of symptoms
1. < 6 weeks 0 2. > 6 weeks 1
A Many more than 10 small joints 5
B Serology negative 0
C. Acute-phase reactants off the charts both ESR and CRP 1
D. Duration of symptoms > 6 weeks 1
My score is 7 and a firm diagnosis for RA. I met the greatest rheumatologist in the world within two weeks of my ER visit. In another month I would have started the drug methotrexate. Presently, I have full blown and seriously progressing RA. This 2010 criteria was right on for me.
For more information on it, Google it. An article that I like is:
2010 Rheumatoid Arthritis Classification Criteria, ARTHRITIS AND RHEUMATISM, Vol.62, No 9, September 2010, pp2569-2581. There is a long list of authors starting with Daniel Aletaha and ending with Frederick Wolfe and Gillian Hawker.
My RA started in a wrist that soon included the other wrist. My GP was treating the first wrist as a sprain (car door yank by the wind) but started blood work as soon as the other started doing the same thing without any provocation. I had a very high RF and sed rate. He said it was RA and booked an appointment for me in the city with a rheumotologist. (way too far in the future for sure!) He confirmed the diagnosis. The GP had put me on MTX and an anti-inflammatory. By the time I saw the specialist, my hands, feet, ankles and elbows had joined the party. I didn’t start getting full relief until I started Enbrel. I put off doing a biologic because of the scary disclaimers. If I didn’t think it was helping me, I know now that it is tremendously. A recent surgery required being off the biologic for 3 weeks. I could barely walk across the floor before I could resume the meds. I thankfully do my injections. I don’t know where I would be without them. This is a progressive disease. I think back and can remember little instances that foreshadowed full RA at least 10 years before it got bad enough to check out. I hope you can find something to help you slow it down. It takes the perfect “cocktail” just for you.
Embrel is a wonder drug! I am glad it is working for you. I appreciate your story, Marcia.