Ritchie et al developed the Articular Index (AI) Score to evaluate joint involvement in patients with rheumatoid arthritis. This can be used to monitor disease activity and the response to therapeutic interventions. The authors are from the Royal Infirmary in Glasgow, Scotland.

Joints examined (26):

(1) temporomandibular

(2) cervical spine

(3) sternoclavicular

(4) acromioaclavicular

(5) left shoulder

(6) right shoulder

(7) left elbow

(8) right elbow

(9) left wrist

(10) right wrist

(11) left metacarpal proximal phalangeal (MCP)

(12) right metacarpal proximal phalangeal

(13) left proximal interphalangeal (PIP)

(14) right proximal interphalangeal

(15) left hip

(16) right hip

(17) left knee

(18) right knee

(19) left ankle

(20) right ankle

(21) left talocalcaneal

(22) right talocalcaneal

(23) left midtarsal

(24) right midtarsal

(25) left metatarsals

(26) right metatarsals



• Although there are left and right temporomandibular, sternoclavicular and acromioclavicular joints, according to Table I only 1 value is given.

• Several of the joints consist of multiple joints (PIP, MCP, others).


Joint on Physical Examination


not tender




tender and patient winces


tender, patient winces and withdraws



total score =

= SUM(points for all 26 joints)



• minimum score: 0

• maximum score: 78

• The higher the score the more extensive the disease activity.

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