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What to expect at your first examination- By Dr. Humeira Badsha

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Once the specialist has asked you questions he or she will examine you. Depending on the kind of arthritis you have they may need to look at all the joints and press on them, and move them. Sometimes the doctor will count how many painful or swollen joints you have and you may have to answer some questions which relate to your functional ability and quality of life. Occasionally it is necessary to make measurements of your spine. This will then help the doctor decide on your treatment.

Xrays: are done to look at the bone and joint and look for joint space narrowing or damage.

Sometimes xrays are not sufficient and the doctor may need a closer look with a scan such as an MRI or CT scan. Ultrasound testing for joints is also a new modality to help with diagnosis.

Blood tests- such as rheumatoid factor (for rheumatoid arthritis), ESR and CRP (for inflammation), uric acid (for gout), ANA (for lupus), and HLAB27 (for Ankylosing Spondylitis) are needed. However, the diagnosis cannot be made on the basis of a blood test alone. The history, examination, xrays and blood tests have to be all taken together.

Rheumatoid factor: This is the most common test done for arthritis. It is present in about 70% of patients with rheumatoid arthritis. However, when patients have typical symptoms of pain and swelling in joints they can be diagnosed with rheumatoid arthritis even if the rheumatoid factor is negative. This is called ‘seronegative rheumatoid arthritis’. In addition, there are many kinds of inflammatory arthritis, such as psoriatic arthritis which cannot be diagnosed on the basis of a blood test.

Anti-CCP antibody is a new test for rheumatoid arthritis. It is present in 65-70% of patients and when present it is almost certain that the patient has rheumatoid arthritis.

ESR or erythrocyte sedimentation rate: is a marker of inflammation in the body. This is generally raised in inflammatory arthritis and normal in osteoarthritis. The ESR can also be raised in infections, malignancy or anemia.

ANA or anti-nuclear antibody is present in 97% of patients with SLE or systemic lupus erythematosus. However, it is not specific for lupus and can be present in other diseases such as arthritis, infections, or raynaud’s.

Uric acid is usually raised in Gout. However, gout is a clinical diagnosis made on the basis of swollen, inflamed joints and not only because of a raised uric acid.

HLA B27 is present sometimes in patients with Ankylosing Spondylitis.

This is one of a set of articles by Dr. Humeira Badsha, Specialist Rheumatologist, for patient awareness.

awareness.

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This web site is run by an Arthritis Specialist based in Dubai, United Arab Emirates. On this site you will find news about the latest in arthritis, information about research results in the field, tips and information and diet and exercise, and much more.

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