Diagnostic Tests for Juvenile Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis Tests: Book Excerpts
Juvenile Rheumatoid Arthritis Diagnosis: Book Excerpts
Tests and diagnosis discussion for Juvenile Rheumatoid Arthritis:
Doctors usually suspect JRA, along with several other
possible conditions, when they see children with persistent joint pain
or swelling, unexplained skin rashes and fever, or swelling of lymph
nodes or inflammation of internal organs. A diagnosis of JRA also is
considered in children with an unexplained limp or excessive
clumsiness.
No one test can be used to diagnose JRA. A doctor
diagnoses JRA by carefully examining the patient and considering the
patient's medical history, the results of laboratory tests, and x rays
that help rule out other conditions.
- Symptoms--One important consideration in diagnosing JRA is
the length of time that symptoms have been present. Joint swelling or
pain must last for at least 6 weeks for the doctor to consider a
diagnosis of JRA. Because this factor is so important, it may be
useful to keep a record of the symptoms, when they first appeared, and
when they are worse or better.
- Laboratory tests--Laboratory tests, usually blood tests,
cannot by themselves provide the doctor with a clear diagnosis. But
these tests can be used to help rule out other conditions and to help
classify the type of JRA that a patient has. Blood may be taken to
test for RF and ANA, and to determine the erythrocyte sedimentation
rate (ESR).
- ANA is found in the blood more often than RF, and both are found
in only a small portion of JRA patients. The RF test helps the
doctor tell the difference among the three types of JRA.
- ESR is a test that measures how quickly red blood cells fall to
the bottom of a test tube. Some people with rheumatic disease have
an elevated ESR or "sed rate" (cells fall quickly to the bottom of
the test tube), showing that there is inflammation in the body. Not
all children with active joint inflammation have an elevated ESR.
- X rays--X rays are needed if the doctor suspects injury to
the bone or unusual bone development. Early in the disease, some x
rays can show cartilage damage. In general, x rays are more useful
later in the disease, when bones may be affected.
- Other diseases--Because there are many causes of joint pain
and swelling, the doctor must rule out other conditions before
diagnosing JRA. These include physical injury, bacterial or viral
infection, Lyme disease, inflammatory bowel disease, lupus,
dermatomyositis, and some forms of cancer. The doctor may use
additional laboratory tests to help rule out these and other possible
conditions.
(Source: excerpt from
Questions and Answers About Juvenile Rheumatoid Arthritis: NIAMS)
Diagnostic Tests for Juvenile Rheumatoid Arthritis: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Juvenile Rheumatoid Arthritis.
Polyarticular Arthritis:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Ascertain that the pain is articular; that is, it is exacerbated by the function of the joint. Detecting synovitis limits the differential to inflammatory arthridites and systemic rheumatic diseases. Findings of synovitis include palpable soft tissue bogginess around a joint, warmth over a joint, or effusion. Involvement of the wrists, elbows, or metacarpophalangeal joints implies inflammatory disease rather than osteoarthritis. Morning stiffness persisting for as long as 1 to 2 hours, relieved by NSAIDs, is typical for inflammatory arthritis, as is a history of a red joint.
Differentiating features include the following: Erythema nodosum: sarcoidosis, inflammatory bowel disease-related arthritis, or Behçet disease. Rash: lupus, Still disease, vasculitis, dermatomyositis, endocarditis, disseminated gonorrhea, or Behçet disease. Fever greater than 40˚C: Still disease, bacterial arthritis, or lupus. Fever preceding arthritis: viral arthritis, Lyme, reactive arthritis, Still
desease, or bacterial endocarditis. Spiking fever: bacterial infection or Still
disease. Splenomegaly: rheumatoid arthritis and lupus. Raynaud: scleroderma, mixed connective tissue disease, or lupus. Oral ulcers: lupus, Behçet disease, or viral arthritis. Dry eyes and mouth: Sjögren syndrome, mixed connective tissue
disease, or lupus. Ocular findings: lupus, Behçet disease, sarcoidosis, or reactive arthritis. Migratory arthritis: gonococcemia, rheumatic fever, meningococcemia, viral arthritis, lupus, acute leukemia, or Whipple disease. Episodic recurrences: Lyme, crystal-induced arthritis, inflammatory bowel disease, Still disease, or lupus. Morning stiffness: rheumatoid arthritis, polymyalgia rheumatica, Still
disease, or viral arthritis. Symmetric small-joint synovitis: rheumatoid arthritis, lupus, or viral arthritis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Acute Monoarticular Arthritis:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Ascertain that arthritis (joint inflammation) is present by eliciting pain on joint motion. A hot, swollen joint with constitutional symptoms such as fever, weight loss, and malaise suggests infection. The skin may hold clues to psoriasis, systemic lupus, viral exanthems, Lyme disease, and others. Erythema nodosum occurs with sarcoidosis or inflammatory bowel disease. Urethritis suggests gonorrhea or Reiter syndrome. A monoarticular presentation of a polyarticular disease may be rarely seen in rheumatoid arthritis, Reiter syndrome, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, and sarcoidosis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
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