History: The onset of RA is usually gradual. The most common symptom is symmetrical joint stiffness in the morning that lasts more than 1 hour. Individuals may also complain of fatigue, unexplained fever, malaise, weakness, loss of appetite (anorexia), weight loss, and dry, sensitive eyes. There may be a family history of rheumatoid arthritis or other autoimmune connective tissue disease (i.e., fibromyalgia, lupus erythematosis). Some individuals may report having had rheumatic fever during childhood. Physical exam: The exam may reveal joint swelling with warm, reddened areas, tenderness to touch, and decreased range of motion. Walking and rising from a seated position may be difficult and grip strength may be markedly diminished. Joints may become deformed as the disease progresses. In more advanced stages, subcutaneous nodules develop in about 20% of cases. Other systemic manifestations may include spleen enlargement (splenomegaly) and carpal tunnel syndrome. Tests: Laboratory tests, which are helpful in making the diagnosis, include serum rheumatoid factor (positive in about 70-90% of RA cases), erythrocyte sedimentation rate (ESR, a non-specific test for inflammation in the body which is elevated in 90% of RA cases), C-reactive protein (another indicator of inflammation), antinuclear antibodies (ANA, present in 20-30% of individuals with RA) and a positive anti-cyclic citrullinated peptide (CCP antibody). Synovial fluid analysis (aspirated from joint space with a needle and syringe) can reveal antibodies and certain types of immune system cells present in RA. The presence of crystal or bacteria in joint fluid suggests other diagnoses. Because RA is a progressive disease, the typical x-ray findings of joint space narrowing, bony erosion and deformities occur in more advanced stages. Serial x-rays can document changes over time and are helpful in monitoring disease progression and treatment efficacy. Bone densitometry (DEXA scan) is a useful diagnostic tool for osteoporosis, a major comorbidity with RA. MRI of affected joints is a sensitive technique for detection of erosions during the early stages of the disease. |
Source: Medical Disability Advisor