.:rheumatoid arthritis:.

discussion in rheumatology tutorial was different from other tutorial. conducted by Prof Shahrir, as usual he did not directly ask what was written in question paper that we got. he has his own way to make our adrenaline peaked. each students had 'opportunity' to answer his question.


we were asked about the rhematoid arthritis (RA) criteria. we answered:


1.rheumatoid factor (+)
2.finger/hands joints 6w or more
3.rheumatoid nodules present
4.involve 3 or more joints
5.morning stiffness more than 1h for more than 6w
6.erosions on xray
7.symmetrical arthritis for 6w or more

he did not approve our answer. then he told us the new criteria:


it has 4 domain:

1.joint distribution (joint pain)
0- no pain
1- 1 medium joint
2- 2-3 medium joints
3- 1-3 small joints
4- 4-10 small joints
5- more than 10 joints

2.serology (Rheumatoid factor, anti CCP)
0- RhF (-) or anti CCP (-)
1- RhF (+) +/- anti CCP (+) less than 3times upper limit (low titer)
2- RhF (+) +/- anti CCP (+) more than 3times upper limit (high titer)

3.duration of synovitis
0- less than 6w
1- more than 6w

4.acute phase reactant (ESR, CRP)
0- ESR, CRP normal
1- ESR high or CRP high


4-5: probable RA
>6: classical


at that time, this criteria had just came out. amazingly, prof shahrir had remembered it well.~the only doctor in rheumatology department PPUKM.


i don't know how wide is this criteria being used. ~~~ask rheumatologist, surely he will know.hahaha.


~ade org tnye prof. mana satu nak guna. prof kata guna criteria yang lama.