Rheumatoid Arthritis Diagnosis
Rheumatoid arthritis diagnosis is based in the revised criteria developed by the American College of Rheumatology in 1987. These criteria are 95% accurate in establishing the diagnosis of this disease. They include the following points.
- Morning stiffness in the joints that lasts for about 1 hour before maximum improvement.
- Arthritis of three or more of the following 14 joint areas (right and left are separate areas)
Arthritis of hand joints including the wrist, metacarpo-phalangeal joint and proximal inter-phalangeal jointSymmetric arthritis meaning that both left and right side are involved simultaneouslyRheumatoid nodules present near the involved jointsRheumatoid Factor blood test is positive by any method in which gives a positive report in less than 5% of normal populationX ray changes in the hand bones showing erosion of bone and reduced calcium in the bones
- right proximal inter-phalangeal joint
- left proximal inter-phalangeal joint
- right metacarpo-phalangeal joint
- left metacarpo-phalangeal joint
- right wrist joint
- left wrist joint
- right elbow joint
- left elbow joint
- right knee joint
- left knee joint
- right ankle joint
- left ankle joint
- right metatarso-phalangeal joint
- left metatarso-phalangeal joint
Of the above criteria at least 4 should be present to establish the diagnosis.
Other tests that have been found to be helpful for Rheumatoid arthritis diagnosis and they include the following
- Rheumatoid Factor test is a useful test for the diagnosis and the evaluation of this disease. In this test doctors detect the presence of antibodies against the Fc portion of the immunoglobulin G. Many tests detect the of presence of antibodies to the immunoglobulin M. So be sure to ask for the immunoglobulin G test. A positive test does not establish the diagnosis as this test is positive in about 5% of the normal population and in 15% above the age of 65years. This test may also be positive in the following conditions too
- sjogren's syndrome
- systemic lupus erythematosus
- interstitial lung disease
- bacterial endocarditis
- hepatitis B infection
The level of rheumatoid factor is helpful in predicting the course of the disease. Higher the level the more aggressive is the disease.
- Anti-CCP (cyclic citrullinated polypeptide) is a test that is better than Rheumatoid Factor in confirming the diagnosis of rheumatoid arthritis as it is normally found in less than 1.5% of the normal population. Its presence signifies a more aggressive disease and a more likely chance of bone destruction.
- Blood analysis will also show the following
- presence of anaemia
- increased erythrocyte sedimentation rate
- increased C reactive protein
Increased erythrocyte sedimentation rate and C reactive protein are indicative of the presence of inflammation.
- X rays early in the course of the disease show no abnormalities. Later on the following changes can be seen
- reduced joint space indicating then destruction of cartilage
- destruction of bone near the joints
- reduced calcification of bone close to the joints
X rays are also helpful in assessing the aggressiveness of the disease and deciding when surgery is required.
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This page was last updated on 31st March 2009.
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