In the 2010 ACR/EULAR classification criteria for Rheumatoid Arthritis, a patient scores ≥6 points and is classified as definite RA. The scoring domains include joint involvement, serology, duration, and acute-phase reactants. Which serology finding gives the HIGHEST score (3 points)?
- A High-positive anti-CCP (>3× upper limit of normal) ✓
- B Low-positive RF with low-positive anti-CCP
- C High-positive RF only
- D Negative RF with positive ANA
Correct answer: A. High-positive anti-CCP (>3× upper limit of normal)
Explanation
In the 2010 ACR/EULAR RA classification criteria, serology is scored as: 0 for negative RF and anti-CCP; 2 for low-positive RF or anti-CCP (≤3× ULN); 3 for high-positive RF or high-positive anti-CCP (>3× ULN). High-positive anti-CCP antibodies (>3× ULN) confer the highest score and the strongest diagnostic specificity (~95%) for RA. ANA positivity has no scoring weight in RA criteria.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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