ARTHRITIS EVALUATION

Joint pain from rheumatoid arthritis is caused by the inflammation present in a joint when the disease is active or when it is inactive if permanent damage has occurred from previous flare-ups

Active rheumatoid arthritis causes the joint to swell because of both thickening of the joint lining tissue (synovium) and because of excess joint fluid. The swollen, inflamed joint stretches and irritates the capsule that surrounds the joint. The joint capsule has nerve endings within it that immediately send pain signals to the brain.

Past rheumatoid arthritis can lead to permanent joint destruction with damaged cartilage, bone, and ligaments. When the damaged joint is used, it can cause intense pain.

Joint Tenderness

The inflamed joint lining tissue irritates the nerves in the joint capsule. When the irritated joint capsule is compressed by external pressure, such as from touching the joint, it is often tender eliciting pain immediately upon compression. This is one of the reasons that rheumatoid arthritis can lead to difficulty sleeping and insomnia.

Joint Swelling

People with rheumatoid arthritis will know when their fingers swell making it hard to get rings on and off. Joint swelling can be experienced in any affected joint reducing the range of motion of these joints.

Joint Redness

Redness may or may not occur in inflamed joints. When it does happen it is the capillaries of the skin that are widened by the adjacent inflammation, also referred to as dilated capillaries. Sometimes the inflammation in the joint is inadequate to cause the capillaries in the skin to dilate.

Joint Warmth

Active inflammation is characterized by warmth of the joints. Doctors look for joint warmth as they monitor the activity of the disease. As rheumatoid arthritis responds to treatment, joint warmth resolves. Sometimes joint warmth is present without visible joint swelling or redness.

Joint Stiffness

Joints that are affected by active rheumatoid arthritis are inflamed and characteristically stiffer in the morning than later in the day. Doctors use the duration of the morning stiffness as a measure of the severity of the active joint inflammation. As rheumatoid arthritis responds to treatment, the duration of the mornining stiffness will lessen in time and severity.

Loss of Joint Range of Motion

Active disease can about more inflammation which can cause a loss in range of motion as the swelling limits movement. This loss of range of motion can become permanent in joints with longstanding RA.

Multiple Joints Affected

Usually, but not always, rheumatoid arthritis affects many joints. Traditionally, RA affects the small joints of the hands, wrists and balls of the feet. It is not uncommon for inflammation to include the knees, elbows, hips, ankles and shoulders. Often time most adults have more than one joint affected.

When four or more joints are inflamed, the condition is referred to as polyarthritis. When only a few joints are inflamed, it is referred to as oligoarthritis. When a single joint is inflamed, it is referred to as monoarthritis. Regardless of how many joints are affected this can be a painful and debilitating disease and should be tested for so that a treatment plan to control flare-ups is begun to control the long term impact of this autoimmune disease.

Limping

When Rheumatoid arthritis affects the hips, knees, ankles or feet, the pain, loss of range of motion and joint swelling all can cause a person with RA to have a noticeable limp. Poor lower extremity function can be a result of other diseases affecting the nerves, muscles and bones, thus, testing to identify if RA is present at any stage of the symptoms helps to initiate proper treatment.

Joint Deformity

Probably the most frightening of symptoms and why it is so easy to deny that RA is causing your symptoms. Often times we shrug off these other early signs as a nerve, muscle or bone issue leaving RA unchecked and treated for a long period of time. This is a huge mistake that results in untreated inflammation that causes the debilitating joint deformity that leaves a permanent disability and limitation to the affected person. A simple blood test can detect early changes. If you test positive and symptoms are still present and other conditions have been ruled out then test again within about 6 months. Sometimes in early stage diagnosis it can be undetected. Onset of RA can be rapid or gradual.

Both Sides of the Body Affected

Symmetric joint involvement ( symptoms on both sides of the body) is a feature of classic rheumatoid arthritis. Symmetrical symptoms, although common, is not always the case for each person with RA.

Loss of Joint Function

By now you have realized that rheumatoid arthritis leads to pain, swelling, and tenderness of the involved joints with a loss of joint function. The swelling and sensitivity impairs full motion and stability of the joint and it becomes incapable of carrying the movement with confidence, balance, and completeness. This loss of joint function leads to limping, lack of coordination, loss of grip and dexterity resulting in disability.

Anemia

The chronic inflammation of rheumatoid arthritis commonly causes the bone marrow to decrease the release of red blood cells circulation. This lowers the red blood count, (RBC) to cause anemia when rheumatoid arthritis is active or flared-up. Anemia of rheumatoid arthritis can spontaneously correct as the inflammation of the disease is quieted by treatment. As you continue to read about RA it becomes quite apparent how important it is for early detection and treatment.

Fever

Fever is not common in RA, however low-grade elevations can occur in some patients when the disease is actively causing inflammation. Most medications for RA can decrease the normal immune response which can require aggressive treatment of infections and or discontinuing RA treatment until resolved.

Evaluation Includes: Complete Blood Count, Basic Metabolic Panel, Uric acid, E Sed Rate, CRP, Rheumatoid Factor

Test Prep: Fasting Required. No food or drink except water for 8 hours prior to testing.