How is rheumatoid arthritis diagnosed? Part - I
The American College of Rheumatology has defined (1987) the following criteria for the classification of rheumatoid arthritis:
- Morning stiffness that lasts more than an hour.
- Arthritis and soft-tissue swelling of 3 or more of 14 joints/joint groups:
- Arthritis of hand joints
- Symmetric arthritis
- Subcutaneous nodules in specific places
- Rheumatoid factor at a level above the 95th percentile
- Radiological changes suggestive of joint erosion
Four criteria need to be met for RA to be confirmed. For example: one of the criteria is the presence of bone erosion on X-Ray. Prevention of bone erosion is one of the main aims of treatment because it cannot be cured. To wait until all of the ACR criteria for rheumatoid arthritis are met is likely to worsen the patients suffering. Most rheumatologists deem it better to treat the patient as early as possible and prevent bone erosion, even if this means treating patients who don’t fulfill the full ACR criteria. The ACR criteria are, however, very useful for categorizing patients with established rheumatoid arthritis, for example for epidemiological purposes.
The doctor may perform a procedure called arthrocentesis. A sterile needle and syringe are used to drain some joint fluid for lab-examination. Analysis of the joint fluid can help to dismiss other causes of arthritis, such as infection and gout. This process also helps in relieving joint swelling and pain. Occasionally, cortisone medications are injected into the joint during the arthrocentesis for rapid relief.
The distribution of joint inflammation is important to the doctor in making a diagnosis. In rheumatoid arthritis, the small joints of the hands, wrists, feet, and knees are typically inflamed in a symmetrical distribution (affecting both sides of the body). When only one or two joints are inflamed, the diagnosis of rheumatoid arthritis becomes more difficult. The doctor may then perform other tests to exclude arthritis due to infection or gout.
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