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How to diagnose rheumatoid arthritis

Affiliation

  • 1 Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds, LS2 9JT, UK.
  • PMID: 11358414
  • DOI: 10.1053/berh.2000.0125
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Authors

Affiliation

  • 1 Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds, LS2 9JT, UK.
  • PMID: 11358414
  • DOI: 10.1053/berh.2000.0125

Abstract

There are difficulties in making an accurate diagnosis of rheumatoid arthritis in its early stages, a principal problem being the fact that its most defining feature is chronicity, which, by definition, takes time to identify. There is substantial evidence that patients with rheumatoid arthritis should be treated early, and the majority are now commenced on therapy when first diagnosed. A logical implication of the early therapy approach is that treatment before rheumatoid arthritis is fully developed may have even greater benefits. This requires patients who are likely to have a persistent, more severe disease to be identified and treated effectively in the very earliest stages. This requires a system of the early specialist referral of suitable patients and the use of effective predictors of patient outcome. This text discusses the early arthritis clinic approach and the current evidence base available for use in constructing management guidelines for such patients.

Affiliation

  • 1 Department of Rheumatology, C4-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
  • PMID: 11840437
  • DOI: 10.1002/art.10117

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  • Search in PubMed
  • Search in NLM Catalog
  • Add to Search

Authors

Affiliation

  • 1 Department of Rheumatology, C4-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
  • PMID: 11840437
  • DOI: 10.1002/art.10117

Abstract

Objective: To develop a clinical model for the prediction, at the first visit, of 3 forms of arthritis outcome: self-limiting, persistent nonerosive, and persistent erosive arthritis.

Methods: A standardized diagnostic evaluation was performed on 524 consecutive, newly referred patients with early arthritis. Potentially diagnostic determinants obtained at the first visit from the patient’s history, physical examination, and blood and imaging testing were entered in a logistic regression analysis. Arthritis outcome was recorded at 2 years’ followup. The discriminative ability of the model was expressed as a receiver operating characteristic (ROC) area under the curve (AUC).

Results: The developed prediction model consisted of 7 variables: symptom duration at first visit, morning stiffness for > or =1 hour, arthritis in > or =3 joints, bilateral compression pain in the metatarsophalangeal joints, rheumatoid factor positivity, anti-cyclic citrullinated peptide antibody positivity, and the presence of erosions (hands/feet). Application of the model to an individual patient resulted in 3 clinically relevant predictive values: one for self-limiting arthritis, one for persistent nonerosive arthritis, and one for persistent erosive arthritis. The ROC AUC of the model was 0.84 (SE 0.02) for discrimination between self-limiting and persistent arthritis, and 0.91 (SE 0.02) for discrimination between persistent nonerosive and persistent erosive arthritis, whereas the discriminative ability of the American College of Rheumatology 1987 classification criteria for rheumatoid arthritis was significantly lower, with ROC AUC values of 0.78 (SE 0.02) and 0.79 (SE 0.03), respectively.

Conclusion: A clinical prediction model was developed with an excellent ability to discriminate, at the first visit, between 3 forms of arthritis outcome. Validation in other early arthritis clinics is necessary.

RA can be very difficult to diagnose, as there is no single test to show whether or not you have the disease. Diagnosis is decided through a combination of blood tests, scans (such as X-ray or ultrasound) and an examination of your joints by a consultant rheumatologist.

Symptoms of RA include painful, stiff, swollen joints. The stiffness is usually worst in the morning and after periods of inactivity. The stiffness in the morning can last for a long time and the joints affected are usually symmetrical (meaning they are the same joints, on either side of the body). If you suspect you may have these symptoms, the first step is to speak to your GP, who will perform an initial examination and may do some blood tests if they think you could have RA.

RA can be very difficult to diagnose, as there is no single test to show whether or not you have the disease. Diagnosis is decided through a combination of blood tests, scans (such as X-ray or ultrasound) and an examination of your joints by a consultant rheumatologist. If you feel that you may have RA, the next step would be to speak to your GP about your concerns. If they feel that it is possible that you have the disease, they will arrange for you to have these tests and be referred to a rheumatologist for diagnosis.

Newly diagnosed pack

Includes New2RA, Fatigue Matters and Medicines and RA

New2RA – A self-help guide for people with newly diagnosed rheumatoid arthritis

Fatigue Matters – A self-help guide for people living with rheumatoid arthritis

Medicines and RA – We believe it is essential that people living with RA understand why certain medicines are used, when they are used and how they work to manage the condition.

How to diagnose rheumatoid arthritis

How to diagnose rheumatoid arthritis

Getting the most from your initial consultation with your GP

Early treatment has been shown to provide improved disease outcomes in RA. It is therefore essential that people with suspected RA get the most out of initial consultations with their GP, putting them on track for earlier referral, diagnosis and treatment.

How to diagnose rheumatoid arthritis

Making a diagnosis of rheumatoid arthritis

Diagnosis of RA is not straight forward as there is no individual test for RA. A diagnosis tends to be made by a consultant rheumatologist on the basis of tests, examination and ruling out other possible causes for symptoms.

How to diagnose rheumatoid arthritis

Understanding your RA blood tests

Blood tests are frequently used to help in the diagnosis of rheumatoid arthritis (RA) but also to assess any potential problems with the various drugs that are used to treat RA.

How to diagnose rheumatoid arthritis

Seropositive and seronegative

Seropositive or seronegative is a term used to describe whether you have rheumatoid factor (RF) and anti-CCP (or ACPA) in your blood; two proteins more commonly found in people with

Imaging in RA

There are a number of different imaging techniques that are used in the diagnosis and monitoring of rheumatoid arthritis, including X-ray, ultrasound and MRI.

Rheumatoid arthritis (RA) is the arthritis of small joints of the body, and an autoimmune condition that under severe situations can also attack internal organs of lungs and heart. Rheumatoid is chronic, severe and a debilitating disease that in absence of appropriate treatment, may cause considerable joint deformation, resulting in serious disability.

It mainly affects women, majority between 30 to 50 years of age, who contribute to 70% of total RA cases. But, children and men can also get affected. In men, it is known to attack more severely, and they remain less responsive to treatment.

Diagnosis Of Rheumatoid Arthritis

The usual symptoms of rheumatoid arthritis are more flu like, and include muscle aches, low grade fever, reduced appetite, and perspiration of feet and hands. But, these symptoms get misdiagnosed as flu signs.

In several cases, additionally, one may also observe swollen, painful and red joints that are warm to touch. This gives a clear identification of rheumatoid arthritis and rules out flu possibilities. In rheumatoid arthritis, the joint symptoms appear symmetrically.

If one of the hands gets affected, the other hand is bound to be affected at the same moment. There is no specific test to identify rheumatoid arthritis.

Doctors diagnose it based on various factors associated with this disease. Still, few tests are there that help to diagnose it.

Physical Examination

Doctor looks for obvious swelling, warmth and redness in the joint areas. Moreover, the doctor analyzes the muscle strength and reflexes of the suspected individual.

Blood Tests

Patients of rheumatoid arthritis show an elevated ESR (erythrocyte sedimentation rate) that is the indicator of inflammatory responses of the body. Other blood tests help in identification of anti cyclic citrullinated peptide (anti-CCP) and rheumatoid factor antibodies.

X Rays

X-rays are utilized by the doctor for prognosis of rheumatoid arthritis. It helps to monitor the progression of the disease over a period, by taking x-ray of the affected joints periodically.

Early Stage Diagnosis Of Rheumatoid Arthritis

The early stage identification is difficult, but rheumatologists use certain criteria to identify the disease.

Morning Stiffness

RA patients usually show stiffness of joints, for minimum of one hour in the morning, soon after getting up.

Swelling Of Three Or More Joints

Fluid accumulation or swelling around three or more joints simultaneously is observed in RA patients.

Hand Swelling

Rheumatoid arthritis patients normally have swelling in at least one area of the arm. You could find them in hand, wrist or finger joints (knowing thumb arthritis symptoms). You will know the symptoms rheumatoid arthritis in hand.

Symmetric Arthritis

When swelling of joints happen symmetrically, on both sides of the body, it is bound to be rheumatoid arthritis.

Rheumatoid Nodules

Presence of rheumatoid nodules within the body, specifically in the pressure points of elbows or knees, identifies it as rheumatoid disease.

Detection Of Rheumatoid Factor

Abnormal levels of rheumatoid factor in the blood confirm the rheumatoid arthritis.

Deformation of Joints

If x-ray identification displays deformation of joints, then one is having a progressive rheumatoid arthritis stage of the disease.

The initial factors of swelling and stiffness usually appear since past six weeks, but probably considered as usual joint pain, by the affected individual.

Symptoms of Rheumatoid arthritis may come or go, intermittently but usually follows a persistent behavior. Having four or more of the above factors officially diagnose and identifies the disease of the joints as rheumatoid arthritis.

Rheumatoid Arthritis (RA) is a chronic autoimmune disease, where the immune system attacks the body cells. It is an inflammatory disorder that affects many joints and tissues, leading the body parts into deformity, if not diagnosed and treated early. As the actual cause of RA is not yet discovered by our scientists, it is very hard to diagnose it. Doctors may have several blood tests and X-rays, to come to a conclusion that a patient is suffering from RA. There are some common symptoms that show an early arthritis. These symptoms may include inflammation of joints with severe pain, mainly in fingers, wrists, elbows, knees, etc. If not diagnosed early, it may affect the other organs like lungs, kidneys, eyes, etc, leading the patient to sudden death.

If a patient, find early symptoms of RA like swelling of joints or having collection of fluids around more than few joints simultaneously; stiffness of joints specially in the morning for at least one-hour; formation of nodules (a knot like structure), especially in elbows and knees where there is in the joints; and if Rheumatoid Factor is found positive in the blood tests. These symptoms may prevail in a patient for at least six weeks and the patient again may gain his health in normality but these are usually persistent.

If a doctor finds these symptoms in a patient, in order to diagnose for RA, he may go through some blood tests and X-rays to get confirmation. Though these blood tests cannot diagnose RA definitely, but can certainly help a patient for their treatment. Some of these blood tests includes: Rheumatoid Factor, Cyclic Citrullinated Peptite (CCP), Erythrocyte Sedimentation Rate (ESR), Blood count, Anti-nuclear antibody, and C-reactive protein (CRP).

  • Rheumatoid Factor: Rheumatoid factor is an antibody found in a patient’s blood, suffering from RA, which binds with other antibodies. These factors are found only in limited population and can increase with age.
  • Cyclic Citrullinated Peptite (CCP): It is a circular peptite that contains amino acid citrulline. These antibodies are found in the blood of a patient suffering from RA. This test falls under Rheumatoid Factor.
  • Erythrocyte Sedimentation Rate (ESR): It is also called sedimentation rate, where the red blood cells sediment in a tube for a period of one hour. It is hematology test for non-specificmeasure of inflammation.
  • Blood Count: It is a type of blood test that measures red cells for anemia. It is a condition where the count of RBC falls chronologically, and lacks to carry out oxygen to the body parts of a patient suffering from RA. But having anemia does not suggest that the patient is having RA.
  • Anti-nuclear Antibody: Also known as antinuclear factor and are present in autoimmune disease like RA
  • C – reactive protein Test (CRP): It is an indicator of inflammation in a patient’s body. This inflammation is more than the normal.

Some X-rays of fractures, tumors, and infections may also be taken by the doctors to diagnose RA. But it may also be done after diagnosis to locate any sort of bone development or joint damage to the patient suffering from RA. So diagnosis is very important before treatment.

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Athritis pain is a severe problem for many people, we hope that these articles will help people to get some relief from suffering.