How is Rheumatoid Arthritis Diagnosed

What is rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disorder. In this disorder, joints are affected by our own immune system. Sometimes, other parts of the body are also affected, like skin, lungs, and heart. Rheumatoid arthritis typically affects the joints of the hands, feet, wrists, elbows, knees and ankles. The joint effect is usually symmetrical which means if one knee or hand is affected, usually the other one gets affected too. Rheumatoid arthritis can also affect body systems, such as the cardiovascular or respiratory systems – because of its destructive nature of spreading, it is additionally referred to as a systemic disease where systemic means ‘entire body.’ It is a chronic progressive disease. The cause of this disease is still not studied clearly. It is said that genetics and some environmental factors can play an important role. The main pathological process is inflammation of the synovial membrane (the inner lining of the joint capsule) and formation of cellular infiltrate. Many factors are believed to play an important role in its progression like TNF (Tumor necrosis factor) and cytokines, although TNF is considered to be the most important. Some interleukins like IL- 1, IL-15, IL-6, IL-17, when blocked provide relief.

 

Diagnosis

The first step to diagnosing if an individual is suspected with RA based on signs and symptoms is to go consult a rheumatologist – a specialist with specific training and skills to diagnose and treat RA. Only a good rheumatologist will help you in the best possible way to cure the disorder. In its early stages, RA may resemble other forms of inflammatory arthritis. Moreover, no single test can confirm RA. Therefore to conduct a proper diagnosis, the rheumatologist will ask questions about personal and family medical history as well as recent and current symptoms, i.e., if you’re observing any pain, stiffness or difficulty of any sort; he may even make you perform a physical exam and order diagnostic tests. Always be patient and cope with what your specialist says. To explain in detail, first and foremost, symptoms should be noted carefully like:

Joints become swollen, slight warmth, painful and stiffness which leads to limited movement within joints. The pain associated with rheumatoid arthritis is classified as nociceptive. Nociceptive is a kind of sudden sharp pain which is felt when the ankle twists or the pain occurring during burns. Many deformities occur like osteoarthritis, ulnar deviation, boutonniere deformity, swan neck deformity, and Z thumb. Many other such deformities can also form depending on age and sex of the individual. Skin is also affected in 30% of RA cases.

Physical examination of the body, especially the joints, is the classical way diagnose the disease. Some additional tests are required to confirm the disease, since our own immune system is involved in this disease. As a part of the physical examination, the doctor examines each joint, searching for any sort of tenderness, swelling, warmth or pain leading to limited movement of the body. The number and pattern of joints affected also indicate RA. For example, RA tends to affect joints on both sides of the body. The physical exam thus helps in revealing other signs and symptoms that may also cause rheumatoid arthritis to grow; these signs may take account of rheumatoid nodules and in some cases low-grade fever.

Imaging test

X-rays are usually performed in order to see the bones. X-rays are by far the best way for imaging the bones (when no other tissue is of importance). Sometimes no changes are seen in the early stages of rheumatoid arthritis. X-rays provide us with the information about inflammation of soft-tissues or loss of space between the joints. Sometimes, additional tests like MRI or ultrasound can also be performed. Also, color Doppler or power Doppler ultrasonography can also be performed. They help to visualize the vascular signs of synovitis (inflammation of synovium).

Blood tests measure inflammation levels and look for biomarkers such as antibodies (blood proteins) linked with RA. People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. In case of rheumatoid arthritis, presence of rheumatoid factor confirms the disease. It is a non-specific antibody. But, if this antibody is not found in the blood, it does not mean that the person does not have the disease. It is an indicator of seronegative arthritis, which occurs in about 15% people. It turns out that in some people this antibody is not found in the early stages of disease and later their blood starts converting into seropositive. This factor is also seen in some other medical conditions like Sjogren’s syndrome or systemic lupus erythematosus.

New types of tests are being established due to low specificity of the above mentioned tests. Some studies are currently being done on anti-citrullinated protein antibodies (ACPAs) and anti-CCPs. Special types of tests are being developed like anti-CCP test and the Anti-MCV assay. Currently, work is being done on POCT (point-of-care-test). This test will detect rheumatoid arthritis in its most early stages. Clinically, the diagnosis is confirmed by inflamed joints (usually 2 or more), stiffness in the joints in morning lasting for more than an hour and the detection of rheumatoid factors or autoantibodies.

Rheumatoid arthritis is very similar to other autoimmune diseases, therefore, while diagnosising, it is quite important to distinguish them from other autoimmune diseases, especially from those where rheumatoid factor is found. According to Nathan Wei, Director of the Arthritis Treatment Center in Frederick, “the early treatment for RA makes all the difference in the world; the sooner we can ease it, the better it is for the patient.” For that reason, one must never be afraid to voice the pain he/she is feeling; because of the disease, the longer RA goes untreated, the chances of dealing with pain lessens, along with increased chances of permanent joint changes and disabilities. Besides, if rheumatoid arthritis goes untouched, it can lead to joint erosion that can affect the functioning of the body in the later years.