Arthritis diagnosis can be difficult as arthritis is an ailment that can be the manifestation of various diseases. Based on just a symptom or test, it is impossible to diagnose arthritis. Most of the time, clinical inquiries and physical examination of a patient provide preliminary information on the several symptoms in which you are experiencing.
The doctor will look at the patterns of your symptoms and a few tests in order to identify the type of arthritis which is affecting you. Sometimes, it may be difficult to reach a confirm diagnosis until more diagnostic tests are utilized.
Generally, arthritis diagnosis is made based on your symptoms, medical history, physical examination, laboratory test, X-ray or other imaging techniques and minimal surgical procedures.
Understanding Your Medical History
At your first consultation, your doctor will listen to your complaints of symptoms which you are experiencing and how it had affected you in your routine activities or work. Then he will gather information on your family history of arthritis which may relate to your symptoms.
Some of the information which the doctor will also require from you includes:
- Your general health conditions
- Details of your previous illness or injury
- Any past surgical operations
- Previous or current medications you are on
- Previous or current treatments
- Your occupation and duties involve
- Your recreational or sports activities
- Your daily diet, drug allergies etc
During your appointment, it is important to give as much information as possible so that your doctor can assess the possible causes of your symptoms which can help in the diagnosis. If you have any records of your medical or family history, it is advisable to bring along so that you will not miss out any information.
It is recommended to jot down all information on a notebook or make a list of questions before the appointment. If you are nervous, it is good to bring someone along like your family member or friends who can help you to disseminate the information or ask questions relating to your case.
Physical Examination Of The Joints
After assessing your symptoms and consolidated the information with regards to your medical history, the doctor will examine your general physical health, focusing primarily on the pain area and affected joints for signs of swollen joints, redness, deformities or any wound. Typically, the doctor will palpate your affected joints to determine the presence of tenderness, joint fluid, bumps or crepitus. He will also check on the degree of stiffness and any loss in joints motion by moving your affected joints.
Other parts of the body such as the hands, eyes, mouth, tongue or skin will also be examined for any signs and symptoms which are related to arthritis. The bodily systems such as nervous system, lungs, heart, gastrointestinal system, liver and kidney are also being evaluated during the physical examination.
Generally, from the medical history and physical examination, the doctor may already have clues on a few suspected types of arthritis. In order to confirm the arthritis diagnosis, your doctor may ask you to go for one or few tests for more concrete information or to rule out the possibilities of other conditions.
Types Of Laboratory And Blood Tests
Blood tests and other laboratory tests is important and valuable diagnostic tool which helps to confirm a diagnosis or assess the severity of the disease. These are usually needed in addition to medical history and physical examination to provide an accurate diagnosis. You will be asked to undergo the following common laboratory tests, depending on the type of arthritis which your doctor suspect is affecting you.
Complete Blood Count: It is a panel of blood test which is used to evaluate the WBC (white blood cell count), RBC (red blood cell count) and the platelet count. Often used to diagnose various conditions such as infection or inflammation. Besides, it is also use to assess the body’s response to certain treatment. Changes in the complete blood count can take place in inflammatory joint (rheumatic) diseases but are not so specific such as neutrophilia in vasculitis, sepsis and acute gout, neutropenia in lupus. Many disease-modifying anti-rheumatic drugs (DMRADs) have bone marrow toxicity and require regular monitoring of the complete blood count.
C-Reactive Protein (CRP): CRP is a marker of inflammation which is produced by the liver following tissue injuries. Conditions such as inflammation, infection and cancerous diseases can evoke an acute-phase response with changes in C-reactive protein (CPR) and complete blood count. CRP is the single most helpful marker of the acute phase response and it may be normal in scleroderma or lupus. If it is found elevated in these conditions, it may be suggestive of the presence of sepsis.
Erythrocyte Sedimentation Rate (ESR): Also known as sedrate or sedimentation rate is a test on the rate of red blood cells to settle within an hour. This is also raised Just like the C-reactive protein (CPR), an increased in ESR points to signs of inflammation, malignancy, and infection.
Rheumatoid Factor (Autoantibodies): Best known auto-antibody that reacts with proteins which are released by the immune system (an antibody direct against the IgG particularly to its Fc fragment). This is the most common test used to diagnose rheumatoid arthritis and the presence can be found in 80% of the patients. However, in minority cases, positive results are found in patients who do not have rheumatoid arthritis. As such, RF test is only useful when used in conjunction with other tests.
Anti-cyclic citrullinated peptide antibody (Anti-CCP Antibodies): These are highly preferable over RF to confirm the presence of rheumatoid arthritis. This test is particularly helpful for patients with rheumatic disease with early involvement of a number of joints. Anti-CCP antibodies are also seen in severe type of disease and can even be found out in patients that are asymptomatic many years before the onset of rheumatic arthritis.
Anti-Nuclear Antibodies (ANA): These antibodies are produced against the nucleus of the DNA. These are detected and are used for the diagnosis of systemic lupus erythematosus (SLE). However, patients with other diseases also can have positive ANA test results, and even perfectly healthy people can have positive ANA test results, so other tests must be completed before a definitive diagnosis can be given.
Uric Acid Levels: Hyperuricemia refers to abnormal high level of uric acid (result of purine metabolism) in the blood which leads to the accumulation of crystals in the joints and tissues, resulting in gout. High levels of uric acid are determined for gout but the presence of normal levels does not exclude the gout diagnosis.
Bone-Specific Alkaline Phosphatase: It is a useful marker to determine active bone formation. This test is specific for bone-related problems such as osteoporosis.
HLA Tissue Typing: Human Leukocyte Antigens (HLA) is a type of proteins which found on the surface of cells in the body. HLA varies from individual to individual and they are used as genetic markers to test for the presence of arthritis conditions. Patients who possess specific genetic markers are more inclined to certain types of arthritis. HLA- DR4 is found in patients with rheumatoid arthritis and HLA- B27 is found in patients with ankylosing spondylitis.
Urinalysis Test: A test which examines a sample of your urine to detect any disorders such as urinary tract infection or kidney disease, which may associated with arthritis.
5 Common Medical Imaging Techniques
Plain radiograph (X-rays): The x-ray can demonstrate the presence of anatomical changes reflecting an important pathological process. Following abnormalities are seen on the plan X-ray.
- Bone density (increases or decreased with localized or generalized changes)
- Soft tissue swelling
- Joint erosion
- Enlargement of bones and their deformity
- Joint space narrowing
- New bone formation
Radionucleotide Bone Scan: This scan is employed for those patients who are presented with bone pain. By using gamma-camera imaging it shows enhanced perfusion, vascularity and bone tumors. It is also valuable for detecting joint sepsis, bone fracture and metastases of cancer to bone.
Computerized Tomography (CT): Also known as CAT scan, utilizes x-rays from different angles to provide a 3-dimensional detailed visualization of the body. It is very suitable for lung, spine, chest and bone injuries imaging. Both provide detailed view of the anatomy through three-dimensional visualization of complex structures, for example facet joints.
Magnetic Resonance Imaging (MRI): An imaging technique which utilizes changing magnetic fields and radio waves to capture the images of different structures in the body. It offers detailed imaging of soft tissue such as muscles, ligaments, tendons and spinal cord.
Ultrasonography: An ultrasound-based diagnostic imaging technique which is useful for confirming the presence of small joint erosion or synovitis and for assistance in guiding accurate injections and aspiration of bursas and joints.
Other Tests And Surgical Procedures
- Bone Mineral Density (BMD): It is a test which measures the density of calcium and other minerals in your bones. BMD test is important for the diagnosis and treatment of osteoporosis.
- Joint Aspiration
As the name implies, this is a procedure in which joint fluid, the synovial fluid is drained by using a sterile needle and syringe. This aspiration process of joint is known as arthrocentesis. The analysis of synovial fluid is the pivotal investigation in case of septic arthritis and intra-articular bleeding. It can also be used to describe other causes of arthritis or joint swelling, for instance, rheumatoid disease and gout.
- Synovial Biopsy
Synovial biopsy involves the removal of tissue lining a joint (synovial membrane) for diagnostic purpose. It basically helps to confirm the presence of conditions such as infections, crystals deposits as in gout, iron deposits, synovial cancer, tuberculosis and rheumatoid arthritis.
Here a piece of muscle tissue is taken via biopsy needle. Next, the tissues and cells from the muscle are view under the microscope. Muscle biopsy is mainly used for the detection of following muscles related problems such as:
– Becker’s muscular dystrophy
– Muscular dystrophy (MD)
– Friedreich’s ataxia
– Duchenne muscular dystrophy (DMD)
Muscle biopsy is also used to identify neuromuscular disorders, abnormalities in the muscle tissues and infections affecting the muscle.
It is a minimally invasive surgical procedure use for examining an interior aspect of a joint that is damaged. Through the use of fibre-optic arthroscope, the cause or problem of the joint can be identified easily. This procedure enables to diagnose as well as repair damaged joint tissue, for instance menisci, ligaments or cartilage. It is also used for treatment of osteoarthritis or affected joints.
- Electromyography (EMG) TEST
This test evaluates and documents the electrical activity generated by skeletal muscles. It checks the functionality of the muscles and nerve’s stimulation of the body. EMG is employed as a diagnostics tool for spotting different neuro-muscular diseases.
Due to emotional feelings of fear, anxieties or stress, many people procrastinate going to the doctor to diagnose for arthritis. However the fact is with early diagnosis of arthritis and treatment, it ensures symptomatic control without changing your quality of life.
Getting an early arthritis diagnosis is essential especially if you are experiencing any signs of pain, swelling or difficulties in moving the affected joint for a prolonged period. Though it may due to a simple strain or injury, it could aggravate into serious problems in the later stage.