Sign or symptom	Definition	LR+	LR−	Percentage with rheumatoid arthritis if sign or symptom is present or absent†
				Present	Absent
Morning stiffness	Stiffness in or around the affected joints for at least one hour after initiating movement	1.9	0.5	39	14
Arthritis of three or more joint areas	Three or more of the following joints noted to be fluid-filled or have soft-tissue swelling: wrist, PIP, MCP, elbow, knee, ankle, MTP	1.4	0.5	32	13
Hand joint involvement	Wrist, MCP, or PIP joints among the symptomatic joints observed	1.5	0.4	33	12
Symmetric arthritis	Right and left extremities involved for one or more of following joints: wrist, PIP, MCP, elbow, knee, ankle, MTP‡	1.2	0.6	29	17
Rheumatoid nodules	Subcutaneous nodules in regions surrounding joints, extensor surfaces, or bony prominences	3.0	0.98	50	25
Serum rheumatoid factor test result positive	Positive result using any laboratory test that has a positive predictive value of 95 percent or more (i.e., is positive in no more than 5 percent of patients without rheumatoid arthritis)	8.4	0.4	74	13
Radiographic changes	Hand and wrist films show typical changes of erosions or loss of density adjacent to affected joints	11	0.8	79	21