Investigations and monitoring of Rheumatoid Arthritis

Here is a discussion of laboratory diagnosis of  rheumatoid arthritis and how to monitor that disease plus Markers of active-diseases and how to monitor side effects of drugs.
Diagnosis includes also clinical picture of  rheumatoid arthritis.
Rheumatoid-arthritis

Investigations
1- Blood
• Normocytic normochromic anemia (anemia of chronic disease) or hypersplenism.
Iron deficiency anaemia due to chronic blood loss,(NSAID).
• WBCs: +++ in acute phase.
if Low :  suspect Felty's syndrome
• Platelets +++  (phase reactants), ---  with felty's syndrome.

2- ESR
• + In active stage.
• +++  In severe cases.
• Normal with treatment and remission.

3- C-reactive protein :  parallel with ++ ESR

Markers of active-diseases (activity) :

•.++ ESR                          •  -- Hb
• ++ c-reactive rotein         • Thrombocytosis .

4- Serology
• Rheumatoid factor (RF) positive in 80 % of cases.
• ANA positive in 20 % of cases (non specific).
• Anti-DNA : negative
• Recently Anti CCP (cyclic citrullinated peptide antibodies) are present in up to 80% of patients with RA with 90% specificity.
 They can detect early disease when RF is negative. CCP can predate the disease by several years.
• Normal complement level.

5- Synovial fluid
 • -- protein, -- glucose, --  Complement.
• Also it is cloudy with increased white cell count.

6- X-ray
• Early  :     - Soft tissue swelling.      -  Periarticular osteoporosis.
                  - Narrow joint space (due to destruction of cartilage)

• Late   :     - Bony ankylosis + deformity.
Investigations of Rheumatoid Arthritis

Other investigations
• Synovial biopsy.
• U/S - C.T scan     - MRI for joint involvement.

 Monitoring of Rheumatoid Arthritis

To establish diagnosis :

  • Clinica criteria                   • Serological tests
. • X-ray                                • Acute phase reactants

To monitor disease activity and drug efficacy :

• Pain                            • Joint tenderness
• Morning stiffness.        •  Acute phase reactants

To monitor disease damage:

• X-ray                         • Functional assesment

To monitor side effects of drugs (drug safety):

• Urine analysis               • Blood picture.
• Blood chemistr e. kidne functions.

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