Read Online The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting On With Your Life by Rita Baron-Faust, Jill Buyon - Free Book Online Page B
Authors: Rita Baron-Faust, Jill Buyon
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that he could just lift me out of the chair because I couldn’t get myself up.
Diagnosing Rheumatoid Arthritis
Rheumatoid arthritis can be difficult to diagnose in its early stages. For some, the full range of symptoms develops over a long period of time; in the early stages of RA only a few symptoms may be present. Symptoms can also vary widely from woman to woman; some have more severe symptoms, while others have only slight problems. Symptoms of RA can also mimic other types of arthritis and autoimmune diseases, such as lupus. So those conditions must first be ruled out.
The first thing your doctor will do is take a medical history, asking you to describe your symptoms, when they began, and how they may have changed or progressed over time. You’ll be asked about the amount of joint pain you experience, how long you feel stiff in the morning, and how long episodes of fatigue last. The doctor will examine your joints for the classic signs of RA, including redness, swelling, and warmth; assess how flexible your joints are; and test your reflexes and muscle strength.
No single test can definitively diagnose RA, but together the tests can help confirm a diagnosis.
Diagnostic criteria set by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) can help distinguish rheumatoid arthritis from other causes of chronic joint problems. 12
They include:
Morning stiffness lasting at least an hour
Arthritis in three or more joint areas, with soft-tissue swelling
Arthritis of the joints of the hand (including the wrist or knuckles)
Symmetric involvement of joints
Rheumatoid nodules
Erosions, bone loss, or other changes seen on an x-ray
A positive blood test for rheumatoid factor (RF) or antibodies to cyclic citrullinated peptides (anti-CCP) .
You need to meet four of these seven criteria, and the first four must have been present for at least six weeks. Together with the results of a series of blood tests, they can add up to a diagnosis of rheumatoid arthritis.
Tests You May Need and What They Mean
Rheumatoid factor (RF) is an antibody found in the blood of most patients with rheumatoid arthritis. Not every woman with RA tests positive for rheumatoid factor—especially early in the disease, when it’s detected in only 50 percent of patients. Eventually the test is positive in around 80 percent of people with RA. If you test negative, you’re said to be seronegative. But RF can also be present in women with other conditions such as lupus and Sj ö gren’s syndrome . So a positive test for RF can support a diagnosis of RA, but by itself it isn’t enough to diagnose the disease. 13
Antibodies to cyclic citrullinated peptides (anti-CCPs) are found in 60 to 70 percent of people with RA. Peptides are microscopic pieces of proteins. Antibodies to CCPs can be found in people who do not have RF and may be present even before the earliest signs of RA appear. If the test is positive, there’s a better than 95 percent chance that you have RA, according to the ACR. Anti-CCP levels can also be a predictor of future joint damage and show how well you’re responding to treatment. 14
Erythrocyte sedimentation rate (ESR or SED rate) gauges how fast red blood cells settle at the bottom of a tube of whole blood within a one-hour period. Any inflammation in the body (such as the flu or a severe infection) increases plasma proteins, such as the clotting factor fibrinogen, which makesred blood cells clump together. These clumps of cells settle faster than single cells. In healthy people, red blood cells fall at a rate of about 20 millimeters per hour; in women with inflammation, the SED rate speeds up to about 100 millimeters an hour. An elevated SED rate is a nonspecific sign of inflammation and is seen in rheumatoid arthritis and other autoimmune inflammatory conditions.
C-reactive protein (CRP) is another marker of inflammation and may be more sensitive than ESR. Your ESR can be normal while CRP can
Diagnosing Rheumatoid Arthritis
Rheumatoid arthritis can be difficult to diagnose in its early stages. For some, the full range of symptoms develops over a long period of time; in the early stages of RA only a few symptoms may be present. Symptoms can also vary widely from woman to woman; some have more severe symptoms, while others have only slight problems. Symptoms of RA can also mimic other types of arthritis and autoimmune diseases, such as lupus. So those conditions must first be ruled out.
The first thing your doctor will do is take a medical history, asking you to describe your symptoms, when they began, and how they may have changed or progressed over time. You’ll be asked about the amount of joint pain you experience, how long you feel stiff in the morning, and how long episodes of fatigue last. The doctor will examine your joints for the classic signs of RA, including redness, swelling, and warmth; assess how flexible your joints are; and test your reflexes and muscle strength.
No single test can definitively diagnose RA, but together the tests can help confirm a diagnosis.
Diagnostic criteria set by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) can help distinguish rheumatoid arthritis from other causes of chronic joint problems. 12
They include:
Morning stiffness lasting at least an hour
Arthritis in three or more joint areas, with soft-tissue swelling
Arthritis of the joints of the hand (including the wrist or knuckles)
Symmetric involvement of joints
Rheumatoid nodules
Erosions, bone loss, or other changes seen on an x-ray
A positive blood test for rheumatoid factor (RF) or antibodies to cyclic citrullinated peptides (anti-CCP) .
You need to meet four of these seven criteria, and the first four must have been present for at least six weeks. Together with the results of a series of blood tests, they can add up to a diagnosis of rheumatoid arthritis.
Tests You May Need and What They Mean
Rheumatoid factor (RF) is an antibody found in the blood of most patients with rheumatoid arthritis. Not every woman with RA tests positive for rheumatoid factor—especially early in the disease, when it’s detected in only 50 percent of patients. Eventually the test is positive in around 80 percent of people with RA. If you test negative, you’re said to be seronegative. But RF can also be present in women with other conditions such as lupus and Sj ö gren’s syndrome . So a positive test for RF can support a diagnosis of RA, but by itself it isn’t enough to diagnose the disease. 13
Antibodies to cyclic citrullinated peptides (anti-CCPs) are found in 60 to 70 percent of people with RA. Peptides are microscopic pieces of proteins. Antibodies to CCPs can be found in people who do not have RF and may be present even before the earliest signs of RA appear. If the test is positive, there’s a better than 95 percent chance that you have RA, according to the ACR. Anti-CCP levels can also be a predictor of future joint damage and show how well you’re responding to treatment. 14
Erythrocyte sedimentation rate (ESR or SED rate) gauges how fast red blood cells settle at the bottom of a tube of whole blood within a one-hour period. Any inflammation in the body (such as the flu or a severe infection) increases plasma proteins, such as the clotting factor fibrinogen, which makesred blood cells clump together. These clumps of cells settle faster than single cells. In healthy people, red blood cells fall at a rate of about 20 millimeters per hour; in women with inflammation, the SED rate speeds up to about 100 millimeters an hour. An elevated SED rate is a nonspecific sign of inflammation and is seen in rheumatoid arthritis and other autoimmune inflammatory conditions.
C-reactive protein (CRP) is another marker of inflammation and may be more sensitive than ESR. Your ESR can be normal while CRP can
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