American College of Rheumatology 20/50/70 criteria (ACR20/50/70)

Felson DT; Pincus T


Basic description

Developed in 1993

The ACR20 is a composite measure defined as both improvement of 20% in the number of tender and number of swollen joints, and a 20% improvement in three of the following five criteria: patient global assessment, physician global assessment, functional ability measure [most often Health Assessment Questionnaire (HAQ)], visual analog pain scale, and erythrocyte sedimentation rate or C-reactive protein (CRP).

ACR50 and ACR70 are the same instruments with improvement levels defined as 50% and 70% respectively versus 20% for ACR20.

The ACR20 was revised in 2007 and the Hybrid ACR Response Measure, combining the ACR20, ACR50, ACR70 and a continuous score of the mean improvement in ACR core set measures, was proposed as a better definition of response to treatment in Rheumatoid Arthritis (RA) clinical trials.


Felson DT; Pincus T

Pincus T for the patient assessment (adapted from the MHAQ)
Physician Assessment Form © 1999, American College of Rheumatology.
To measure disease activity in rheumatoid arthritis (RA) clinical trials
Therapeutic area
  • Skin and Connective Tissue Diseases
  • Musculoskeletal Diseases
  • Immune System Diseases
Therapeutic indication

Arthritis, Rheumatoid

Type of Clinical Outcome Assessment (COA)
  • Composite
PRO and ClinRO - Composite measure including biomarkers
Original language(s)
  • English for the USA
Bibliographic reference(s) of the original questionnaire

Felson DT, Anderson JJ, Boers M, Bombardier C, Chernoff M, Fried B, Furst D, Goldsmith C, Kieszak S, Lightfoot R, et al. The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis Rheum. 1993 Jun;36(6):729-40 (PubMed Abstract)

Felson DT, Anderson JJ, Boers M, Bombardier C, Furst D, Goldsmith C, Katz LM, Lightfoot R Jr, Paulus H, Strand V, et al. American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995 Jun;38(6):727-35 (PubMed Abstract)

Felson DT, Anderson JJ, Lange ML, Wells G, LaValley MP. Should improvement in rheumatoid arthritis clinical trials be defined as fifty percent or seventy percent improvement in core set measures, rather than twenty percent? Arthritis Rheum. 1998 Sep;41(9):1564-70 (Full text article)

American College of Rheumatology Committee to Reevaluate Improvement Criteria. A proposed revision to the ACR20: the hybrid measure of American College of Rheumatology response. Arthritis Rheum. 2007 Mar 15;57(2):193-202. Erratum in: Arthritis Rheum. 2007 Dec 15;57(8):1574 (Full text article)

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