Diagnostic Tests for Rheumatoid arthritis
Diagnostic tests for Rheumatoid arthritis:
A diagnosis of rheumatoid arthritis is made after a full medical and family history and physical and diagnostic testing are evaluated by a qualified health care professional. Medical testing may include a wide variety of tests, including a rheumatoid factor test, complete blood test (CBC), C-reactive protein, erythrocyte sedimentation rate, joint X-rays, and an analysis of the "lubricating" fluid in the joints (synovial fluid).
Rheumatoid arthritis: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Rheumatoid arthritis
includes:
Rheumatoid arthritis Tests: Book Excerpts
Rheumatoid arthritis Diagnosis: Book Excerpts
Tests and diagnosis discussion for Rheumatoid arthritis:
Handout on Health Rheumatoid Arthritis: NIAMS (Excerpt)
Rheumatoid arthritis can be difficult to diagnose in its
early stages for several reasons. First, there is no single test for the
disease. In addition, symptoms differ from person to person and can be
more severe in some people than in others. Also, symptoms can be similar
to those of other types of arthritis and joint conditions, and it may
take some time for other conditions to be ruled out as possible
diagnoses. Finally, the full range of symptoms develops over time, and
only a few symptoms may be present in the early stages. As a result,
doctors use a variety of tools to diagnose the disease and to rule out
other conditions.
Medical history: This is the patient's description
of symptoms and when and how they began. Good communication between
patient and doctor is especially important here. For example, the
patient's description of pain, stiffness, and joint function and how
these change over time is critical to the doctor's initial assessment of
the disease and his or her assessment of how the disease changes.
Physical examination: This includes the doctor's
examination of the joints, skin, reflexes, and muscle strength.
Laboratory tests: One common test is for rheumatoid
factor, an antibody that is eventually present in the blood of most
rheumatoid arthritis patients. (An antibody is a special protein made by
the immune system that normally helps fight foreign substances in the
body.) Not all people with rheumatoid arthritis test positive for
rheumatoid factor, however, especially early in the disease. And, some
others who do test positive never develop the disease. Other common
tests include one that indicates the presence of inflammation in the
body (the erythrocyte sedimentation rate), a white blood cell count, and
a blood test for anemia.
X rays: X rays are used to determine the degree of
joint destruction. They are not useful in the early stages of rheumatoid
arthritis before bone damage is evident, but they can be used later to
monitor the progression of the disease. (Source: excerpt from Handout on Health Rheumatoid Arthritis: NIAMS)
Arthritis: NWHIC (Excerpt)
Blood tests may reveal anemia and
the presence of an antibody called rheumatoid factor (RF). However, some
people with RF never develop rheumatoid arthritis, and some people with
the disease never have RF. (Source: excerpt from Arthritis: NWHIC)
Diagnosis of Rheumatoid arthritis: medical news summaries:
The following medical news items
are relevant to diagnosis of Rheumatoid arthritis:
Diagnostic Tests for Rheumatoid arthritis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Rheumatoid arthritis.
SPLENOMEGALY, ACUTE OR SUBACUTE:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine tests include a CBC, platelet count, sedimentation rate, chemistry panel, febrile agglutinins, serum haptoglobins, ANA test, Monospot test, serum protein electrophoresis, tuberculin test, chest x-ray, EKG, and flat plate of the abdomen.
If there is jaundice, a hepatitis profile, red cell fragility test, and blood smear for parasites should be done. If there is fever, serial blood cultures, leptospirosis antibody titer, and smear for malarial parasites should be done. If there is a petechial rash, a coagulation profile should be done. Lymph node biopsies and bone marrow examinations may be necessary. A CT scan of the abdomen and radionuclide scan for liver and spleen size and ratio should be done. The assistance of a hematologist or infectious disease expert should be sought. A surgeon may need to be consulted for an exploratory laparotomy.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
SPLENOMEGALY, CHRONIC:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The diagnostic workup of chronic splenomegaly is similar to that for acute splenomegaly. A splenoportogram may be helpful in diagnosing portal vein thrombosis. Angiography may be helpful in diagnosing a splenic aneurysm. A liver biopsy, splenic aspiration and biopsy, and bone marrow biopsy may all be helpful in diagnosing the reticuloendothelioses such as Gaucher's disease.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Splenomegaly:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If you detect splenomegaly during a routine physical examination, begin by exploring associated signs and symptoms. Ask the patient if he has been unusually tired lately. Does he frequently have colds, sore throats, or other infections? Does he bruise easily? Ask about left upper quadrant pain, abdominal fullness, and early satiety. Finally, examine the patient’s skin for pallor and ecchymoses, and palpate his axillae, groin, and neck for lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Splenomegaly:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you detect splenomegaly during a routine physical examination, begin by exploring associated signs and symptoms. Ask the patient if he has been unusually tired lately. Does he frequently have colds, sore throats, or other infections? Does he bruise easily? Ask about left-upper-quadrant pain, abdominal fullness, and early satiety. Finally, examine the patient’s skin for pallor and ecchymoses, and palpate his axillae, groin, and neck for lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Splenomegaly:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The diagnosis of splenomegaly is made by palpation of a mass in the left upper quadrant. Harrison’s Textbook of Medicine cites that a spleen is palpable in 3% of normal college freshmen, whereas in tropical countries, the incidence of splenomegaly may reach 60% (1). Percussion is also used to delineate the size of the spleen. Percussion is only approximately 60% accurate in most studies, with palpation about 50% accurate. To palpate the spleen, the patient is in the supine position with the knees flexed to decrease abdominal muscle tone. Begin the examination by palpating the right lower quadrant and move upward across the abdomen as the patient breathes in deeply. Beginning the examination low in the abdomen, allows the lower edge of a markedly enlarged spleen to be detected.
Testing
A. Diagnostic imaging. The most accurate methods of determining spleen size include nuclear scans, computed tomography (CT) scan, and ultrasound. Ultrasound offers the most sensitivity and specificity, with the widest availability at the lowest cost. Magnetic resonance imaging has an advantage over CT scan in that it allows for delineating the blood flow patterns that cause congestion in the spleen. None of the methods are reliable in determining the underlying cause of splenomegaly.
B. Clinical laboratory tests. Most of the laboratory tests used in splenomegaly are those used to delineate other systemic disease processes (2–4). A complete blood count with peripheral smear will identify many of the hematologic diseases that cause splenomegaly. These include elevated white blood cell levels associated with leukemias, spherocytes in spherocytosis, and anemias. A bone marrow biopsy may show increased production of those cells that are low in the peripheral blood, leading to the diagnosis of hypersplenism. Also, the biopsy may show lymphocyte infiltration, increased myeloid elements, blast cells, fibrosis, abnormal staining in disease processes (e.g., amyloidosis), and macrophages in storage-related diseases (2).
Studies such as 51CR-labeled red blood cell count, platelet survival, and splenic survival studies help to determine if the spleen is sequestering an abnormal number of cells.
Diagnostic assessment
A. The diseases that are associated with splenomegaly include:
1. Infectious diseases. Infectious mononucleosis, bacterial endocarditis, tuberculosis, sarcoidosis, acquired immune deficiency syndrome, cytomegalovirus infection, hepatitis, splenic abscess, histoplasmosis, and tropical diseases.
2. Inflammatory diseases. Connective tissue disease, Felty’s syndrome, and serum sickness.
3. Abnormal blood flow. Cirrhosis; hepatic, splenic, or portal vein obstruction; and portal hypertension.
4. Storage diseases. Gaucher’s disease, Nieman–Pick disease, and Hand-Schuller-Christian disease.
5. Infiltrative disease. Leukemia, lymphoma, and Hodgkin’s disease.
6. Chronic anemia. Spherocytosis, sickle cell disease, and thalassemia.
B. Hypersplenism occurs when the size and activity of the spleen interfere with normal cells in the peripheral blood and increased bone marrow production of these cells. The treatment of hypersplenism is reversal of the underlying cause or splenectomy. Splenectomy can be performed by a laparoscopic technique. Preoperative pneumococcal vaccine should be considered for patients undergoing splenectomy.
References
1. Fauci A, Braunwald E, Isselbacher K, et al., eds. Harrison’s principles of internal medicine, 14th ed. New York: McGraw-Hill, 1998:347–350.
2. Nelson W, Behrman R, Kliegman R, Arvin A, eds. Nelson textbook of pediatrics, 15th ed. Philadelphia: WB Saunders, 1996:1439.
3. Rakel R. Saunders manual of medical practice. Philadelphia: WB Saunders, 1996:610.
4. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician 1998;58(6):1313–1320.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
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
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
Splenomegaly:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Complete an abdominal assessment. Examine the patient’s skin for pallor and ecchymoses. Palpate his axillae, groin, and neck for lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Splenomegaly:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
The findingof splenomegaly is usually made on physical exam.Most common causes of enlarged spleenin pediatric population are viral infection, trauma, hemolytic anemia,cardiac failure, and malignancy.History and physical exam provide cluesfor diagnosis and any subsequent investigation.CBC providesinformation about hematologic, infectious, and inflammatory processes.Finding of pancytopenia may indicatebone marrow dysfunction or portal hypertension with hypersplenism.Increased sedimentation rate suggestsinfectious, inflammatory, or neoplastic process.Bacterial, fungal, and other culturesmay be performed with suspected infection.Bone marrow exam is useful in diagnosisof histiocytoses, lysosomal storage disorders, and some infections(e.g., disseminated histoplasmosis).Liver function tests and abdominalU/S with Doppler methods should be performed with suspectedportal hypertension.Abdominal U/S and CT locateand define extent of splenic masses.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Splenomegaly:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you detect splenomegaly during a routine physical examination, begin by exploring associated signs and symptoms. Ask the patient if he has been unusually tired lately. Does he frequently have colds, sore throats, or other infections? Does he bruise easily? Ask about left upper quadrant pain, abdominal fullness, and early satiety. Finally, examine the patient's skin for pallor and ecchymoses, and palpate his axillae, groin, and neck for lymphadenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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