RHEUMATOID ARTHRITIS: DIAGNOSIS

Evolution and clinical manifestations

Although a precise cause of origin is not known, we know very well the alterations of the body tissues associated with "rheumatoid arthritis. This disease begins with an" inflammation of the synovial membrane (a kind of lining of the joints). The inflammatory process of the synovium, which will soon extend to tendons and bursae, produces a lot of fluid that pours into the joint, around the tendons or inside the bursae. Under normal conditions this liquid, called synovial, is important to ensure nourishment to the articular cartilage, protect the joints from impacts and facilitate the sliding between the various anatomical structures. When it is excessive, however, it causes widespread swelling; characteristic is that of the fingers, which take on the typical spindle shape.

The persistence of inflammation leads to a growth of inflammatory tissue towards the joint, around the tendons or inside the bags. The degenerative process also affects the articular cartilage, which is consumed to affect the underlying bone causing erosions that are the cause of the joint deformity. Over time the inflammation becomes chronic, the inflammatory tissue becomes fibrous or scarred. The consequent thickening of intra-articular tissues, associated with cartilage degeneration, bone erosions and swelling, significantly reduces the mobility of the joint.

Diagnosis

The diagnosis of rheumatoid arthritis begins with a "thorough medical history, followed by a physical examination. Listening to the ailments told by the patient and asking specific questions, the rheumatologist specialist searches for useful elements to formulate the correct diagnosis. This preliminary visit, combined with a few simple tests. blood is sometimes sufficient to diagnose rheumatoid arthritis.

As far as blood tests are concerned, inflammation indices and some antibodies are evaluated. Among the inflammatory indices we mention the erythrocyte sedimentation rate (ESR) and the C reactive protein (CRP); the most frequently sought antibodies are rheumatoid factor (FR) and antibodies to citrullinated cyclic peptides (anti-CCP). These antibodies are not specific but their presence, in subjects who have a characteristic clinical picture, plays an important role not only for the diagnostic phase but also for the prognostic one. In fact, it has been shown that high levels of rheumatoid factor and anti-CCP antibodies during the early stages of the disease seem to be associated with a greater risk of severe joint damage. It should be noted that these antibodies can also be present in subjects who have other diseases but also in healthy people and that about 35% of patients with rheumatoid arthritis do not have these antibodies in their blood.

In addition to blood tests, instrumental tests such as radiographs and joint ultrasound should also be performed in the initial phase and in the follow-up of the disease. In particular, joint ultrasound in recent years has assumed an increasingly important role in the management of patients suffering from this pathology.