Rheumatoid Arthritis Diagnosis Tests
I’ve recently discovered an E-book on the subject of rheumatoid arthritis relief called “Conquer Arthritis Now” by medical researcher Chris Callahan. I was pleasantly surprised to find that it’s the ultimate guide to understanding rheumatoid arthritis and putting an end to the pain it causes. This well-written document cites proven evidence from research studies and clinical trials to empower arthritis sufferers to take charge of their healing and conquer their pain for good. To Be Sure: Arthritis cannot be cured, but the symptoms of arthritis can. That’s why Conquer Arthritis Now focuses on easy, affordable ‘lifestyle management’ techniques that anyone can use to end pain and prevent it from coming back. Click Here For A Conquer Arthritis Now Product Review
I have arthritis that affects many of my joints … Could It Be rheumatoid arthritis and how the doctor?
There are over 100 different types of arthritis. Most of them involve inflammation. When a patient goes to a rheumatologist for a diagnosis, there is a process of elimination to arrive at the correct diagnosis. This removal process is called differential diagnosis.
The differential diagnosis can be a difficult task because so many forms of arthritis, particularly inflammatory forms of arthritis are similar. The following is a list of types of arthritis inflammatory that can be seen and should be considered when evaluating a patient with symptoms of inflammatory arthritis.
Rheumatoid arthritis (RA)
RA is a chronic autoimmune inflammatory disease that can affect any joint in the body but preferentially attacks the peripheral joints (fingers, wrists, elbows, shoulders, hips, knees, ankles and feet. It can also affect organ systems non-spouses, such as the lungs, eyes, skin and cardiovascular system. The onset of RA can be insidious, slow-nonspecific with symptoms, including fatigue, malaise, loss of appetite, low fever, weight loss, and vague aches and pains, or it may have sudden onset of inflammation involving multiple joints. The joint symptoms usually occur bilaterally and are symmetrical. The damage to the joints called "erosion" can be seen with magnetic resonance imaging early or X-ray later in the disease. Approximately 80% of patients with RA have high levels of rheumatoid factor (RF) or anti-CCP.
Juvenile Rheumatoid Arthritis (JRA)
JRA describes a group of arthritic conditions that occur in children under 16 years. Three forms of JRA exist, including oligoarticular (1-4 joints), polyarticular (> 4 joints), and systemic onset Still's disease. It is associated with organ damage significant internal and may also have fever and rash, in addition to joint disease. Juvenile idiopathic arthritis, is considered like the type that most resembles adult RA, and is responsible for approximately 30% of cases of JRA. Most children with idiopathic arthropathy Juvenile negative for RF and their prognosis is generally good. Roughly 20% of patients with polyarticular JRA have elevated RF and these patients appear to be at greater risk of chronic disease, the progressive destruction of joints and damage. Uveitis, an inflammatory condition of the eye is a common finding in oligoarticular JRA, especially in patients who are antinuclear antibodies (ANA) positive. The dangerous characteristic of uveitis is that may cause relatively few symptoms so carefully screening is recommended to prevent blindness.
Lupus erythematosus (SLE)
SLE is a chronic autoimmune inflammatory disease that may involve the skin, joints, kidneys, brain and blood vessel walls. At least 4 of the following symptoms that have been made by the American College of Rheumatology are usually present for a diagnosis must be made:
• by a red butterfly shaped the face, affecting the cheeks;
• rash typical of other body parts;
• The sensitivity to sunlight;
• Mouth ulcers;
• Joint inflammation (Arthritis);
• fluid around the lungs, heart or other organs;
• Kidney dysfunction;
• Low white blood cell count, low red blood cells due to hemolytic anemia, or platelet count;
• nerve or brain dysfunction;
• Positive results of a blood test for ANA, and
• Positive results of a blood test for antibodies to double-stranded DNA or other antibodies, including anti-Smith or antiphospholipid antibodies.
Patients with lupus can have significant inflammatory arthritis. Therefore, lupus can be difficult to distinguish from RA, especially if other signs and symptoms of lupus are minimal.
Myositis
Polymyositis (PM) and dermatomyositis (DM) are types of inflammatory muscle diseases. These conditions typically present with bilateral (both sides) a muscular weakness. In the case of DM, a rash can be with a sign. Diagnosis consists of four main features, including elevation of creatine kinase (CK), signs and symptoms such as muscle weakness, elevated muscle enzymes (creatine kinase, aldolase), electromyograph (EMG) abnormalities, and muscle biopsy positive. Often, abnormal laboratory test may be considered, including the presence of autoantibodies such as antinuclear antibodies (ANA), and antibodies associated with myositis.
In both PM and DM, inflammatory arthritis may be present and may resemble RA – including participation in the lung. In RA, however, unless an overlap syndrome – ie., a patient with rheumatoid arthritis and muscle disease) is present, muscle function should be normal. In addition, PM and DM, erosive joint disease is unlikely. RF and anti-CCP antibodies are generally higher in RA and non-PM or DM.
Spondyloarthropathies (SA)
A group of arthritic conditions called spondyloarthropathies, which include reactive arthritis, psoriatic arthritis reaction, ankylosing spondylitis, arthritis and enteropathica are a class of diseases that cause inflammation throughout the body, especially in parts of the spine and other joints where tendons attach to bones. They can also cause pain and stiffness in the neck, upper and lower back, tendonitis, bursitis, heel pain, and fatigue. They are often called seronegative arthritis. seronegative "The term ' means that laboratory tests for markers such as rheumatoid factor were negative. The symptoms of SA adults include:
• Return and / Or joint pain;
• Morning stiffness;
• Sensitivity to nearby bones;
• Sores on the skin;
• Inflammation of the joints on both sides of the body;
• ulcers of the skin or mouth;
• rash on the soles of the feet, and
• Eye inflammation.
In some cases of AS, peripheral arthritis resembling rheumatoid arthritis may be present. careful history and physical examination can usually distinguish between these syndromes, especially if illness is obvious that this is aggravating inflammation (psoriasis, a disease IBD). Additionally, since RA is rare in the end joints of the fingers (DIP joints), if these joints are involved inflammatory arthritis, the diagnosis of SA is promoted. Usually, RF and anti-CCP antibodies are negative in South Africa, although in some psoriatic arthritis cases there may be an increase in RF and anti-CCP.
Associated Crystal Arthritis
Monosodium urate disease (gout)
The drop is due to deposition of monosodium urate crystals in a joint. Gouty arthritis is usually sudden onset, very painful, with signs of significant inflammation on examination (red, hot, swollen joints). Gout can affect almost any joint in the body, but typically affects "cool" regions, including the toes, feet, ankles, knees and hands. Diagnosis is made by removing fluid from a joint and examining the fluid under a polarizing microscope. Patients may also have elevated serum levels of uric acid.
Most cases, gout is an acute disease that affects a joint, and is easily distinguished from RA. However, in rare cases, chronic inflammation may erosive grow and affect more joints. And where tophi (deposits of uric acid under the skin) are present, it can be difficult to distinguish erosion RA. However, the analysis of crystal joints or tophi and blood tests should be useful to distinguish gout from RA.
Calcium pyrophosphate deposition disease (CPPD, pseudogout)
CPPD disease is caused by deposits of crystals of calcium pyrophosphate dehydrated in a commune. The body's reaction to these crystals, leads to significant inflammation. Diagnosis includes:
• Detailed medical history and physical examination;
• Remove the liquid of a joint use of a needle;
• Joint ray X to show the crystals deposited on the cartilage (chondrocalcinosis);
• Blood tests to rule out other diseases (eg, RA or OA).
In most cases, CPPD arthritis presents with acute arthritis affecting one or more joints. However, in some cases, CPPD disease may have multiple chronic symmetrical erosive arthritis similar to rheumatoid arthritis. RA disease CPP disability can usually be distinguished by examination of joint fluid showing crystals of calcium pyrophosphate, and blood tests, including RF and anti-CCP, which should be negative for arthritis CCPD.
Sarcoidosis Arthritis
Sarcoidosis is a type of inflammatory arthritis. The majority of patients with this disease have a lung disease, eye and skin disease are the surest sign next common disease. In most cases, the diagnosis of sarcoidosis can be made on clinical presentation and x-ray alone. Patients suffer severe arthritis, painful nodules under the skin on the shins (erythema nodosum), and a chest radiograph showing enlargement of lymph NIOD. In some cases, the demonstration of a specific type of change inflammation, called noncaseating granuloma on biopsy of tissue is needed to definitive diagnosis.
Arthritis may be present in approximately 15% of patients with sarcoidosis, and in rare cases may be the only sign disease. In rheumatoid acute sarcoidosis, a joint disease is usually rapid in onset, symmetrical, involving the joints of the ankle. The knees, wrists and small joints of the hands may be involved. In most cases of acute disease, lung and skin diseases are also present. Chronic sarcoid arthritis usually involves one or maybe a few joints and because of its erosive nature can often be difficult to distinguish RA.
Arthritis polymyalgia rheumatica (PPR) / time
PMR is a form of arthritis that causes inflammation of the tendons, muscles, ligaments and tissues around joints. It is characterized by large muscles (shoulders, hips, thighs, neck) pain, pain, stiffness morning, fatigue, and in some cases, fever. It may be associated with arthritis in the time / giant cell arthritis (TA / GCA) is a related but more severe inflammation in which major blood vessels can cause complications such as blindness, aneurysms and cramping in the arms or legs (claudication members) due to inflammation and narrowing of major blood vessels in the chest and extremities. PMR is diagnosed when the clinical picture is accompanied by elevated markers of inflammation (ESR and / or CRP). If temporal arthritis suspected (headaches, visual disturbances, lameness members), a temporal artery biopsy may be necessary to make the diagnosis.
PMR and TA / GCA may present with symmetrical inflammatory arthritis similar to rheumatoid arthritis. These diseases can often be distinguished by blood tests. In addition, headaches, acute visual disturbances, and muscle pain are important rare in RA, and if they are present, PMR and / or TA / GCA should be considered.
Infectious arthritis
Many infections can manifest as arthritis or another because direct infection or joint due to joint autoimmune inflammation. In most cases the infection may lead to acute arthritis common unique, but in some cases, chronic arthritis affecting a few joints or more may be present. Because infections can lead to missed significant complications, it is essential to have a high index of suspicion of infection in patients with acute or chronic polyarthritis.
Lyme disease
Lyme disease is an infection with a type of bacteria called spirochetes. The disease is manifested by rash, swollen joints and flu-like symptoms, caused by the bite of an infected tick. Symptoms may include:
• A rash skin, often resembling a bulls-eye (target lesion);
• Fever;
• Headaches;
• muscle pain
• neck stiffness and
• Swelling of knees and other large joints.
The diagnosis of Lyme disease is generally made by blood tests. If, however, the only common chronic arthritis develops, joint analysis of fluid or joint tissue biopsy can be necessary for diagnosis. Lyme arthritis can usually be distinguished from RA by clinical presentation and blood tests.
Rheumatic fever (ARF)
Rheumatic fever is an inflammatory disease that can develop after infection with the bacterium Streptococcus (Strep Throat and scarlet fever). The disease can affect the heart, joints, skin and brain. Symptoms include:
• Fever;
• Pain articular
• Arthritis (especially in the knees, elbows, ankles and wrists);
• Joint swelling, redness or heat;
• Abdominal pain;
• Skin rash
• subcutaneous nodules;
• A proper movement disorder (Sydenham's chorea)
• Nosebleeds;
• heart problems, which may be asymptomatic.
The diagnosis of ARF is made by an evaluation clinical and blood tests for antibodies against the streptococcal protein. ARF and RA may have similar clinical features including arthritis and nodules. However, ARF can usually be distinguished from RA by clinical presentation. The rash and migratory arthritis are rare in RA. The use of blood tests is also useful.
Viral arthritis (hepatitis B and C, parvovirus, EBV, HIV)
Arthritis may be a symptom of many viral diseases. This makes a great viral infections masquerading. The duration is usually short, and it disappears generally itself without any lasting effect. Clinical signs in adults:
• The Joint symptoms occur in up 60%. These may be symmetrical and affect the small joints of the hands, wrists and ankles and knees. Morning stiffness is also present.
• Parvovirus B19 is a very common viral infection that resembles RA.
• The diagnosis of viral arthritis is made by serological tests. A high percentage of patients with hepatitis C may have high titers of RF. Therefore, the RF testing is not useful to distinguish between hepatitis C and RA. However, in these situations, testing for anti-CCP may be useful for anti-CCP has not been demonstrated significantly higher in remote areas of infection with hepatitis C.
So as you can see … "It is not easy … "
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:
Arthritis Treatment
Let’s Talk RA