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Rheumatoid Arthritis – Diagnosis | Johns Hopkins

(calm music) – So the diagnosis of Rheumatoid Arthritis, the most important focus for a Rheumatologist are the clinical symptoms that a patient is presenting with. By that I mean what is the patient experiencing is the patient telling us that he or she is experiencing pain, stiffness, or swelling in the joints? Are we concerned that there is Arthritis, which again means inflammation in the joints. We listen to the patient’s story, that is what defines for us whether we are concerned for Rheumatoid Arthritis or not. (calm music) Two tests that many people are familiar with is one, a very old test known as Rheumatoid Factor, and two a rather new test known as Anti-CCP Antibodies.

These tests can help us in confirming the diagnosis of Rheumatoid Arthritis, but the test by themselves even if they are positive, will not make the diagnosis of Rheumatoid Arthritis, what do I mean by that? Well let’s take the first test, Rheumatoid Factor, Rheumatoid Factor is an age old test that can be positive in many different conditions just having a positive Rheumatoid Factor does not define for me Rheumatoid Arthritis. But as I said I have to look at Rheumatoid Factor in the right clinical picture again, the patient and the patient’s symptoms is the key focus. On the other hand, the newer test Anti-CCP Antibody, is highly specific for Rheumatoid Arthritis.

What do I mean by that? I mean that when I see a patient with high levels of Anti-CCP Antibodies, my concern for Rheumatoid Arthritis is very high, it’s almost as if there’s a 99% chance that somebody with high titres of Anti-CCP Antibodies will have Rheumatoid Arthritis. But let’s flip the coin, and you may ask me, does every patient with Rheumatoid Arthritis have Anti-CCP Antibodies? The answer to that is again no, as a Rheumatologist we have to go back to our patient, that patient with very high titres of Anti-CCP Antibodies do they yet have joint symptoms or not? If they have the right joint symptoms, the right Antibody, yes they have Rheumatoid Arthritis. There are some other tests that we use, markers of inflammation and again that people may be familiar with those, ESR and C-Reactive protein they’re telling us that there’s inflammation in the body and again in the right patient this helps us make the diagnosis of Rheumatoid Arthritis.

(calm music) So I think that’s again, something which we are beginning to understand better, that our patients with Rheumatoid Arthritis are not just going to come to us and say I have swollen joints, I have painful joints but they are going to tell us about more than just that and they will often tell us, I’m very tired, I’m very fatigued and my fatigue is something that I’ve never experienced before, this is an unusual tiredness which is, has nothing to do with what I do in my day. Some of the other things that patients may be experiencing may be disturbed sleep as a part of the inflammation in their body. They may also experience anxiety, depression, because of the pain and the stiffness that they’re experiencing. So I think as physicians it’s very important for us to focus on what else are the patients telling us besides the symptoms in their joints. (calm music) So a Joint Count means that we examine every single joint so let’s say if I am examining a hand, I am touching, I am feeling and I am putting some pressure on what I am trying to understand is number one, is there tenderness in the joint? Which means pain in the joint.

Is there swelling in the joint? Is there deformation, or is there limited range of motion in the joint? So using those criteria, we walk through several joints. The fewer joints that are involved, the better it is for the patient and that gives us a sense of how active Rheumatoid Arthritis is, how do we adjust treatment. Are we happy with the way the patients are doing at that point or do we need to do more, to control the inflammation in their joints? (calm music) The new RA criteria basically focuses on four evaluations, we evaluate the joint, so we examine the joint looking for tender and swollen joints, we see how many tender and swollen joints does the patient have and we give them a particular score for that so that’s one. The second is duration of symptoms, if a patient has duration of symptoms in their joints, again pain, stiffness, swelling for more than six weeks that counts as one score towards the diagnosis of Rheumatoid Arthritis, the third evaluation is that of markers of inflammation. ESR and C-Reactive Protein as we have mentioned before, if someone has high ESR or C-Reactive Protein that again goes towards the score for the diagnosis of Rheumatoid Arthritis and the final evaluation is that of Rheumatoid Factor and Anti-CCP Antibodies.

We’ve talked about them, if they are present or if particularly if they are in high numbers, that again goes as either one or two scores for the diagnosis of Rheumatoid Arthritis. We then add up the score, and a score of six or above meets the criteria for Rheumatoid Arthritis. So the only thing that I want people to recognize, is that on the basis of these four criteria only, we can make the diagnosis of Rheumatoid Arthritis. We don’t need ultrasound, we do not need MRI, we do not need evidence of X-ray damage, et cetera. And the reason this has changed the way we have diagnosed Rheumatoid Arthritis is because we are diagnosing Rheumatoid Arthritis much earlier now. Before the joint damage occurs, before the deformities occur, before the X-ray damage occurs.

So it has really changed the way and how we are now diagnosing this disease and early diagnosis means we can start treating early as well. (calm music).

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