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The american college of rheumatology 1991

revised criteria for the classification of global
functional status in rheumatoid arthritis
1. Marc C. Hochberg MD, MPH Professor of Medicine1,2,*,
2. Rowland W. Chang MD, MPH Assistant Professor of Medicine1,3,
3. Isaac Dwosh MD Associate Professor of Medicine1,4,
4. Stephen Lindsey MD Associate Professor of Medicine1,5,
5. Theodore Pincus MD Professor of Medicine1,6,
6. Frederick Wolfe MD Clinical Professor of Medicine1,7

Article first published online: 9 DEC 2005

DOI: 10.1002/art.1780350502

Copyright © 1992 American College of Rheumatology

Issue

Arthritis & Rheumatism

Volume 35, Issue 5, pages 498–502, May 1992

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How to CiteAuthor InformationPublication HistoryFunding Information

How to Cite

Hochberg, M. C., Chang, R. W., Dwosh, I., Lindsey, S., Pincus, T. and Wolfe, F. (1992), The
american college of rheumatology 1991 revised criteria for the classification of global functional
status in rheumatoid arthritis. Arthritis & Rheumatism, 35: 498–502.
doi: 10.1002/art.1780350502

Author Information
1. 1

American College of Rheumatology Subcommittee on Functional Status and Disease

Severity in Rheumatoid Arthritis (Diagnostic and Therapeutic Criteria Committee of the
Council on Research).
2. 2

Epidemiology and Preventive Medicine, University of Maryland School of Medicine,

Baltimore
3. 3

Rehabilitation Medicine, Northwestern University Medical School, Chicago, Illinois

4. 4

Queen's University Faculty of Medicine, Kingston, Ontario, Canada

5. 5

Eastern Virginia School of Medicine, Norfolk

6. 6

Theodore Pincus, Microbiology, Vanderbilt University School of Medicine, Nashville,

Tennessee
7. 7

University of Kansas School of Medicine, Wichita.

*Correspondence: Marc C. Hochberg MD, MPH Professor of Medicine, American College of

Rheumatology, 60 Executive Park South, Suite 150, Atlanta, GA 30329

Publication History

1. Issue published online: 9 DEC 2005

2. Article first published online: 9 DEC 2005
3. Manuscript Accepted: 28 JAN 1992
4. Manuscript Received: 21 JAN 1991
Funded by

• NIH. Grant Number: AM-21393

• Aging Medical Information System

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Abstract

Objective. To develop and validate revised criteria for global functional status in rheumatoid
arthritis (RA(.
Methods. Revised criteria were formulated and tested for criterion and discriminant validity in
325 patients with RA.

Results. The revised criteria developed are as follows: class I = able to perform usual activities of
daily living (self-care, vocational, and avocational); class II = able to perform usual self-care and
vocational activities, but limited in avocational activities; class III = able to perform usual self-
care activities but limited in vocational and avocational activities; class IV = limited in ability to
perform usual self-care, vocational, and avocational activities. Usual self-care activities include
dressing, feeding, bathing, grooming, and toileting; vocational and avocational activities are both
patient-desired and age-, and sex-specific. The distribution properties of this classification
schema were superior to those of the original Steinbrocker criteria. Mean Health Assessment
Questionnaire scores were significantly (P < 0.0001) different between, and increased across, the
4 classes.

Conclusion. Although there are limitations inherent in the use of global ordinal scales, the
American College of Rheumatology revised criteria will be useful in describing the functional
consequences of RA. A more detailed quantitative measure of physical disability should be used,
however, for optimal monitoring of patients' clinical status in office practice and clinical
research.

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