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Rheumatoid Arthritis

Morning stiffness, fatigue, joint pain and swelling. These common initial features of Rheumatoid Arthritis (RA) do not differ substantially from other forms of inflammatory arthritis.There is also a wide range of other conditions that can mimic RA. The ambiguity and overlap of symptoms – especially in its early stages—can make RA difficult to diagnose.

Accurate and early detection can potentially save your patients from the irreversible joint damage, systemic complications, and considerable morbidity.1

Recognizing RA

Common, initial clinical features of RA include:2-4

  • Stiffness – patients may note being particularly stiff in the morning, and may also note pain on movement and tenderness
  • Polyarticular joint involvement – patients may report symptoms in five or more joints, though this is highly variable
  • Palindromic joint swelling – patients often report swelling in one or two joints that lasts a few days to weeks; it may disappear completely, only to return later in the same or other joints, with a pattern increasing over time
  • Non-specific systemic symptoms – find out if the patient is experiencing primarily fatigue, malaise, or depression, as these symptoms frequently precede other symptoms by weeks to months

RA affects approximately 1% of the world's population1,5





Achieving Better RA Outcomes

RA is a systemic autoimmune disease characterized by chronic inflammation in the synovial membrane of the joint. In later stages of the disease, joint deformity and progressive physical disability5 are common, but by then, the damage is irreversible. The goal, though, is to diagnose patients earlier so that better outcomes can be achieved.

Valuable Tools to Aid in Diagnosis

One of the most important and helpful criteria in reaching a diagnosis is the blood test to identify a specific set of antibodies that are known biomarkers for assessing RA. As not one test that can on its own reach a diagnosis, there are multiple blood tests that can be performed in the diagnostic process.

International guidelines classification criteria recommend laboratory testing for:6

  • Rheumatoid Factor (RF IgM)
  • Anti-Cyclic Citrullinated Peptide (CCP)
  • Erythrocyte Sedimentation Rate (ESR)
  • C-Reactive Protein (ACPA)

Numerous international guidelines recommend RF IgM and anti-CCP as first line tests. CCP antibodies appear in the early stages of rheumatoid disease, and RF IgM is the major RF autoantibody in RA and are detected in 60-80% of RA patients.5,6

RF has proven to be the most useful disease marker of RA;8 and the association between high titer RF IgM status and a poor prognosis indicates that RF may have a role in the pathogenesis of RA. As active disease approaches, RF IgM and CCP levels surpass RF IgA levels.

If your patients are exhibiting one or more RA symptoms, testing can help provide a quicker diagnosis, while potentially ruling out other possible diseases. Testing is simple, specific and reliable. Discover how antibody testing can aid in the diagnosis of RA and why they are such a valuable tool for your practice.

Allergy Testing

Tests

Diagnostic tests give reliable results that support primary care physicians as well as specialists in providing optimal patient management.

References
  1. Suresh E. Diagnosis of early rheumatoid arthritis: what the non-specialist needs to know. J R Soc Med. 2004;97:421-424. 
  2. Revenson T, Schiaffino KM, Majerovitz D, et al. Social Support as a Double-edged Sword: The Relation of Positive and Problematic Support to Depression Among Rheumatoid Arthritis Patients. Soc Sci Med. 1991;33(7)807-813. 
  3. Louati K, Berenbaum F. Fatigue in chronic inflammation- a link to pain pathways. Arthritis Res Ther. 2015;17:254. 
  4. Arthritis Foundation. Palindromic Rheumatism. http://www.arthritis.org/about-arthritis/types/palindromic-rheumatism/. Accessed October 2017.  
  5. Symmons D, Mathers C, Plefler B. The global burden of rheumatoid arthritis in the year 2000. Global Burden of Disease 2000. http://www.who.int/healthinfo/statistics/bod_rheumatoidarthritis.pdf. Accessed October 2017. 
  6. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010 Sep;62(9):2569-81. 
  7. Nell VP, Machold KP, Stamm TA, et al. Autoantibody profiling as early diagnostic and prognostic tool for rheumatoid arthritis. Ann Rheum Dis. 2005;64:1731-1736.  
  8. Song YW, Kang EH. Autoantibodies in rheumatoid arthritis: rheumatoid factors and anticitrullinated protein antibodies. Q J Med. 2010;103:139-146.