Rheumatoid Arthritis Diagnosis
Rheumatoid arthritis diagnosis is difficult; because many other diseases show similar symptoms and symptoms of rheumatoid arthritis too are not very noticeable initially. Even after months of the first onset of joint pain, blood reports and x-rays are normal. And if at all, the disease is diagnosed, it becomes important to discover whether it is type 1, which is benign, or type 2, which is aggressive, so as to treat it properly.
As a rule, some findings like morning stiffness, affected joints on both sides of the body, at a time three joints affected, nodules below the skin, changes in x-rays and positive rheumatoid factor can indicate the possibility of rheumatoid arthritis.
There are several types of blood tests to determine the possibility of the disease.
Rheumatoid factor is an important indicator of RA. These are antibodies which get collected in the synovium of the affected joint. They are found in 80% of the cases of RA. Though they are the indicators of some other diseases too, their presence marks a strong possibility of rheumatoid arthritis to type 2.
Erythrocytic Sedimentation Rate (ESR) Test is also done to find out the presence of RA. In this test, patient's blood is taken in a test tube and observed for the number of erythrocytes that settle at its bottom. The higher this number (sed rate), the more is the intensity of the disease. Again, this test too points towards many other conditions, so it is not used for the diagnosis, but for deciding the severity of the disease.
CRP or C-Reactive Protein level is also observed for rheumatoid arthritis diagnosis. The more this level, the more intense is the disease. But again, as sometimes obesity also may be the reason of increase in CRP, the physician should consider patient's BMI (body-mass index), while considering CRP level the in the patient, suspected of RA.
Another marker is Anti-CCP Antibody Test. This is the best test to diagnose RA. If there are antibodies to Cyclic Cirtullinated Peptides (CCP), it can be said in advance that the patient is going to develop RA, even before s/he shows symptoms.
Tests for anemia also are done, because it is caused commonly in RA patient. It is necessary to test blood frequently to see the amount of RBCs and iron in the blood.
A rarely done test is analysis of synovial fluid to see the presence of markers of joint destruction.
Various imaging tests are done to diagnose RA. One of them is x-rays, which is not of much help, as it cannot take image of soft tissue and hence cannot find out the disease in its early stage.
DEXA (Dual Energy X-ray Absorptiometry) scan is one more test. This can find out early bone loss, that is, up to 2 to 27 months after onset. Damage shown in x-rays along with raised rheumatoid factor together predict strongly the progression of joint damage.
Other helpful techniques are power Doppler ultrasonography (PDUS) or quantitative ultrasound (QUS). The former is reliable for observing the progress of inflammation in the joint, while the later is used for osteoporosis too, and can find out bone damage in fingers, which points towards early RA.
A specially designed MRI (Magnetic Resonance Imaging) equipment, which is named as extremity MRI may find out bone damage in hands of RA patients, which cannot be found out by x-rays. But for confirmation, evaluation to further level is needed.
Thus, though there are various techniques available for rheumatoid arthritis diagnosis, the disease is quite difficult to find out.
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