Rheumatoid Arthritis
Rheumatoid arthritis is a systemic autoimmune disease which initially attacks the synovium, a connective tissue membrane that lines the cavity between joints and secretes a lubricating fluid.
The affect of rheumatoid arthritis can progress to the degree that it is crippling. Deformities distinctive to late-stage rheumatoid arthritis such as ulnar deviation of the bones of the hands, or swan-neck deviation of the fingers occur because muscles and tendons on one side of the joint may overpower those on the other side, pulling the bones out of alignment.
Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks itself. The pattern of joints affected is usually symmetrical, involves the hands and other joints and is worse in the morning. Rheumatoid arthritis is also a systemic disease, involving other body organs, whereas osteoarthritis is limited to the joints. Over time, both forms of arthritis can be crippling.
Rheumatoid Arthritis Diagnosis
RA can begin very gradually, or it can strike quickly. The first symptoms are pain, swelling, and stiffness in the joints. The most commonly involved joints include hands, feet, wrists, elbows, and ankles, although other joints may also be involved. The joints are affected in a symmetrical fashion. This means that if the right wrist is involved, the left wrist is also involved. Patients frequently experience painful joint stiffness when they first get up in the morning, lasting for perhaps an hour. Over time, the joints become deformed. The joints may be difficult to straighten, and affected fingers and toes may be permanently bent (flexed). The hands and feet may curve outward in an abnormal way.
Many patients also notice increased fatigue, loss of appetite, weight loss, and sometimes fever. Rheumatoid nodules are bumps that appear under the skin around the joints and on the top of the arms and legs. These nodules can also occur in the tissue covering the outside of the lungs and lining the chest cavity (pleura), and in the tissue covering the brain and spinal cord (meninges). Lung involvement may cause shortness of breath and is seen more in men. Vasculitis (inflammation of the blood vessels) may interfere with blood circulation. This can result in irritated pits (ulcers) in the skin, tissue death (gangrene), and interference with nerve functioning that causes numbness and tingling.
Rheumatoid Arthritis Diagnosis - test
Rheumatoid Factor This is the most useful diagnostic test because 80% of people with RA eventually show a high concentration of rheumatoid factor in their blood. Rheumatoid factor is an antibody produced against immunoglobulin G. (Antibodies are proteins the body manufactures to fight off foreign substances). However, since not all people with RA have rheumatoid factor, and because other diseases can test positive for it, this test by itself is not conclusive.
Sed Rate the sed rate or ESR (erythrocyte sedimentation rate) measures how fast red blood cells (erythrocytes) fall to the bottom of a glass tube filled with the patient's blood. The higher the sed rate, the more inflammation the patient has. Elevated sed rates are usually found with RA, but they also occur with other conditions.
Hemocrit A hemocrit measures of the volume of erythrocytes in the blood. Red blood cells carry oxygen throughout the body via a pigment called hemoglobin. A low hemocrit means that a person has too few red cells in the blood, and therefore too little hemoglobin, resulting in an insufficient supply of oxygen to the cells. This is called anemia. Anemia is common with RA. Many other conditions, however, can also cause anemia.
Synovial fluid analysis Synovial fluid is obtained through arthrocentesis. In this procedure fluid is withdrawn from a joint and analyzed. Active inflammation makes synovial fluid cloudy and abnormally thin, with higher than normal protein and white blood cells. Conditions other than RA can produce these abnormalities.
Citrulline antibody Citrulline antibody is present in most patients with rheumatoid arthritis. It is used in the diagnosis of rheumatoid arthritis when evaluating patients with unexplained joint inflammation. A test for citrulline antibodies is most helpful in looking for the cause of previously undiagnosed inflammatory arthritis when the traditional blood test for rheumatoid arthritis, rheumatoid factor, is not present. When the citrulline antibody is found in a patient's blood, there is a 90-95% likelihood that the patient has rheumatoid arthritis.
Antinuclear Antibodies (ANA) An antinuclear antibody (ANA) test measures the amount and pattern of antibodies in your blood that work against your own body (autoimmune).
C-Reactive Protein (CRP) This is a type of protein that shows up in your blood during episodes of acute inflammation or infection. A high result serves as a general indication of acute inflammation. It must be noted that even in known cases of inflammatory disease, such as rheumatoid arthritis and lupus, a low CRP level is possible, and is not indicative of no inflammation.
Anti-CCP antibodies Anti-CCP antibodies are potentially important surrogate markers for diagnosis and prognosis in rheumatoid arthritis (RA), because they:
are as sensitive as, and more specific than, IgM rheumatoid factors (RF) in early and fully established disease
may predict the eventual development into RA when found in undifferentiated arthritis
are a marker of erosive disease in RA
may be detected in healthy individuals years before onset of clinical RA
Radiology X-rays can reveal cartilage damage that causes joint space narrowing. They can also show bone erosion and localized osteoporosis. In the early stages of RA, x-rays are not very useful since joint damage is usually not present. When several joints are involved, however, a physician may elect to x-ray one joint (usually hands) as a baseline for comparison over time.
More detailed information about Rheumatoid Arthritis Diagnosis
There are no tests available that can absolutely diagnose RA. Instead, a number of tests exist that can suggest the diagnosis of RA. Blood tests include a special test of red blood cells (called erythrocyte sedimentation rate), which is positive in nearly 100% of patients with RA. However, this test is also positive in a variety of other diseases. Tests for anemia are usually positive in patients with RA, but can also be positive in many other unrelated diseases. Rheumatoid factor is an autoantibody found in about 66% of patients with RA. However, it is also found in about 5% of all healthy people and in 10-20% of healthy people over the age of 65. Rheumatoid factor is also positive in a large number of other autoimmune diseases and other infectious diseases.
A long, thin needle can be inserted into a synovial joint to withdraw a sample of the synovial fluid for examination. In RA, this fluid has certain characteristics that indicate active inflammation. The fluid will be cloudy, relatively thinner than usual, with increased protein and decreased or normal glucose. It will also contain a higher than normal number of white blood cells. While these findings suggest inflammatory arthritis, they are not specific to RA.
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