How is the diagnosis made?

“Rheumatoid arthritis is an important concept that has been developed recently to aggressively treat the patient within the therapeutic window of opportunity. This is variable, but IRA’s consensus was:

  • Early RA: < 24 months
  • Established disease: > 24 months
  • Late disease: > 5 years
  • The diagnosis of RA in early disease may be difficult. The following, if present would favour RA

    • Persistent inflammatory arthritis of more than 4 joints.
    • Many active joints

    High ESR and/or CRP

    • Positive IgM RF or anti-CCP2 (Antibody to CCP is more specific than RF)
    • Radiographic changes of juxtaarticular osteopenia, erosions and joint space narrowing.

    To safely diagnose RA, several tests are necessary. Few of these tests are: “

    The first step in the diagnosis of rheumatoid arthritis is the history (medical history) . Your doctor will ask you various questions about your complaints. This is followed by a physical examination. It checks to see if your joints are swollen, if your mobility is impaired, or if there are other signs of inflammation.

    If your doctor suspects RA, in the next step, he'll look for signs of inflammation in your bloodstream.Various parameters provide indications that an inflammation is present:

    • Increased erythrocyte sedimentation rate (ESR)
      The ESR indicates how fast the solid components of the blood separate from the liquid components by gravity. If the solid blood components settle faster in a suitable vessel at the bottom than normal, this indicates an inflammation.
    • Increased CRP values CRP (C-Reactive Protein) is a protein that is produced in large quantities in the liver when inflammation occurs.
    • Proof of Rheumatoid Factor (RF)
      If the rheumatoid factor (an antibody that binds to an endogenous protein) can be detected in the blood, this is an indication that the immune system is overly active - a characteristic of autoimmune diseases. If the rheumatoid factor can be detected, RA is likely. However, the rheumatoid factor can not be demonstrated in all RA patients, and conversely, positive RF does not necessarily mean that rheumatoid arthritis is present.
    • Positive anti-CCP test
      The anti-CCP test is used to detect cyclic citrullinated peptides (CCPs), which are also considered to be signals of an overactive immune system. If the test is positive, there is an RA in nine out of ten cases.

    Your doctor may also use imaging techniques like Magnetic Resonance Imaging (MRI) or X-Ray. Based on the recordings, it is possible to assess how far the disease has progressed or in which state the affected joints are located.

    The sooner the diagnosis of rheumatoid arthritis is made, the better. For early treatment can significantly reduce the risk of permanent damage to the joints and maintain their functionality. Ideally, treatment should therefore be started within the first six months after diagnosis. At the same time, this also increases the chance of achieving a so-called remission, meaning freedom from symptoms. Achieving a permanent remission is the goal of RA treatment.

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