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Rheumatoid arthritis: diagnosis, initial symptoms and tests to diagnose autoimmune disease.
L'rheumatoid arthritisit's asystemic chronic inflammatory disease of uncertain etiology, herdiagnosisit's not easy at all and sometimes it happens by exclusion. We advise against, whoever finds himself reading a list of symptoms, to hypothesize a do-it-yourself diagnosis. On this page we will explain which indicators and laboratory tests are required to lead to a possible onerheumatoid arthritis diagnosis.
These notions are purely informative, do not claim to becompletefor no text, even if academic, can it substitute to some extent the opinion of an expert rheumatologist.
Rheumatoid arthritis: what it is
As stated, it is a chronic inflammatory disease with inflammatory sites located mainly at the level of thearticular synovial membrane(this disease affects all joints in the body). Thecourseit is very variable as well as the prognosis of difficult unpredictability unless accompanied by constant monitoring.
The damage caused can be manifold. If we want to break away from the classic list of symptoms, we can say that rheumatoid arthritis can induce joint damage such as:
- Progressive joint destruction
- Loss of joint function
With a consequent reduction in the quality of life of those affected. From an epidemiological point of view, therheumatoid arthritisit seems to be more frequent in women than in men. It is incorrect to speak ofrheumatoid arthritis when youngas this pathology can arise in all ages andagethe most frequent onset is between 45 and 65 years.
Symptoms cannot be the only diagnostic element of rheumatoid arthritis. For informational purposes only we report the symptoms of this autoimmune disease.
- Symmetrical joint pain (on both shoulders, on both hands, both elbows, knees, fingers, ankles, feet, wrists ...)
- Swelling of small joints (especially fingers)
- Variable morning stiffness but which generally tends to disappear within an hour
- Other widespread pains in the body
- General malaise
- Lack of energy
- Depression (secondary symptom connected to physical discomfort)
As stated, the symptoms alone cannot justify a diagnosis of rheumatoid arthritis. To diagnose this disease, experts refer to precise diagnostic criteria.
Rheumatoid Arthritis: Diagnosis
The doctor must observe joints affected by arthritis, generally it is arthritis of the proximal interphalangeal, metacarpophalangeal and wrists and in any case symmetrical arthritis, present on both joints.
Among the various criteria that lead torheumatoid arthritis diagnosisreference is made to the presence of rheumatoid nodules and to a blood test that should highlight the so-called rheumatoid factor.
What are rheumatoid nodules?
Rheumatoid nodules are formations made up of agglomerates of granulomas (in practice formations of dead tissue) that have a size that can vary from that of a small pea to the size of a walnut.
In general, rheumatoid nodules are present on the extensor surfaces of the limbs, at the level of the buttocks (buttocks) or in other areas of the body exposed to repeated trauma. Similar formations can also be found in the joint capsules or at the level of the tendons, in the walls of the vessels, in the eye or even in the heart or lungs (in this case we also speak ofCaplan syndrome).
Only the rheumatologist can perform onediagnosiscareful and establish case-specific therapy. For diagnosis and to understand thecourse, very important are the radiological findings that can vary dramatically during the phases of the disease.
Inearly diagnosisthe first evocative sign of rheumatoid arthritis is thereduction of the joint line, that is, the space between the bone heads that reflects the expression of cartilage destruction. Subsequently, what was once a slight reduction in the joint line can turn into larger losses.
TherePCRit cannot be taken as a "diagnostic indicator" as the CRP is high in case of acute exacerbations while there may be spontaneous or drug-induced remissions. Generally, the serum concentration of CRP decreases after treatment with drugs such as "NSAIDs".
Complete blood count
In the acute phases, alterations of theblood count. An increase in white blood cells (neutrophilic leukocytosis) and platelets (platelets) can be seen as a signal of the immune response. In the acute phases, anemia is also often associated (reduction of hemoglobin and red blood cells).
Other tests for diagnosis
For thediagnosis of rheumatoid arthritisthe specialist examines many factors. Not just the symptoms but the entire clinical picture. Typically, among the required laboratory analyzes is research:
- Of the rheumatoid factors
- Anti-citrulline antibodies
It is important to emphasize that todaythere is no rheumatoid arthritis testthat has complete specificity. There are no "pathognomic tests", so the positivity of a test does not give certainty of diagnosis for the disease. For this reason, all laboratory tests must be scrupulously and critically evaluated by the rheumatologist.
20-30% of patients withdiagnosis of rheumatoid arthritisresults “negative” looking forrheumatoid factors. "Seronegative" Rheumatoid Arthritis presents acoursemore benign than the variant that is found with high levels of rheumatoid factors.
Other tests to evaluate:
- Complement components (C3, C4 and anti C1Q)
- Ana (anti-nucleus antibodies)