Signs and symptoms of Rheumatoid arthritis:
The common main symptoms are pain, swelling and stiffness of the affected joints. This is usually worse in the morning or after a resting period (Walker and Whittlesea, 2012). Joints affected in the disease are shown in figure b in appendix.
In addition, there are other symptoms associated with Rheumatoid arthritis that occur in extra-articular organs. Figure a in appendix, demonstrates examples of the extra articular features of rheumatoid arthritis.
Patients with suspected persistent synovitis of undetermined cause should be referred urgently to a specialist even if blood tests present a negative rheumatoid factor (NICE clinical guidance, 2009). N.B. synovitis is inflammation of the lining of the joints and this should be explained to patients.
Early diagnosis of RA is very important in order to initiate treatment. This is extremely essential as it leads to better therapy outcomes allowing prevention of functional disability (NICE clinical guidance, 2009; Walker and Whittlesea, 2012).
Diagnosis of RA is based on patient’s history, presenting symptoms and clinical findings.
There are three different criteria that can be used in order to determine whether the patient has RA. There is ARA criteria, DAS28 and ACR 20(Walker and Whittlesea, 2012). The American Rheumatism Associated criterion for the diagnosis of RA is summarized in figure c in appendix.
A number of investigations have to be carried out in order to confirm the diagnosis of the disease.
Inflammatory markers such as CRP and ESR can be measured. However, they may not be elevated in active disease; nonetheless they are useful when monitoring response to treatment (Walker and Whittlesea, 2012).
A blood test for rheumatoid factor in people with suspected RA should be carried out. Rheumatoid factor is an auto-antibody and is commonly found in Rheumatoid arthritis (Walker and Whittlesea, 2012). Moreover, some people with RA may not have Rheumatoid factor (this is termed seronegative), in these cases other investigations need to be carried out to confirm diagnosis of the disease. Furthermore, this rheumatoid factor is not specific to RA only but can be involved in other conditions including chronic lung and liver diseases (NICE clinical guidance, 2009; Walker and Whittlesea, 2012).
A more specific test to RA includes measuring anti-cyclic citrullinated peptide antibodies. These are more useful to confirm diagnosis of RA in patients with negative RF. They are also used to determine the most appropriate combination therapy for a patient (Walker and Whittlesea, 2012).
X-rays of the hands and feet can be useful for the early detection of RA, particularly in patients with persistent synovitis in these joints (NICE clinical guidance, 2009; Walker and Whittlesea, 2012).
Unfortunately there is no cure for rheumatoid arthritis. Nonetheless, treatment can control the symptoms of the condition as well as prevent any permanent...