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Rheumatoid Arthritis N026

Last amended 
5 September 2017
Current RMA Instruments
Reasonable Hypothesis
50 of 2017
Balance of Probabilities
51 of 2017
Changes from previous Instruments

SOP Bulletin 198

ICD Coding:
  • ICD-9-CM Codes: 714.0, 714.1, 714.2, 714.81
  • ICD-10-AM Codes: M05, M06
Brief description

Rheumatoid arthritis is a chronic symmetric, inflammatory, peripheral polyarthritis. It can lead to joint deformity and destruction if not sucessfully treated.  Associated features outside of the joints, affecting a wide range of organs and tissues occur in about 40% of cases over the lifetime of the disease.

Confirming the diagnosis

Diagnosis is difficult, particularly in the early stages of disease.  Distinctive features and extrarticular manifestations are generally absent until later stages.  There is no single test or clinical feature that is diagnostic.  Diagnosis is based on the clinical findings (including duration of symptoms), serology and other blood test results, and exclusion of diseases with similar clinical features (including psoriatic arthritis, acute viral polyarthritis, polyarticular gout and systemic lupus erythematosus).

The relevant medical specialist is an rheumatologist.

Additional diagnoses covered by SOP
  • Rheumatoid arthritis of the spine
  • Rheumatoid lung
  • Rheumatoid vasculitis
  • Felty’s syndrome
Conditions not covered by SOP
  • Rheumatic fever#
  • Juvenile rheumatoid arthritis#
  • Ankylosing spondylitis*
  • Non-rheumatoid inflammatory arthritis

* another SOP applies

# non-SOP condition

Clinical onset

Clinical onset will generally be when symptoms of peripheral arthritis in multiple joints, subsequently diagnosed as rheumatoid arthritis, first developed.

Clinical worsening

The course of the disease and the response to treatment are variable.  Good control or remission early in the disease process is the aim of therapy.  An inability to obtain a timely diagnosis and appropriate specialist care may be a potential cause of clinical worsening for this disease.