Diagnosing Arthritis and Other Rheumatic Diseases
Diagnosing arthritis and other rheumatic diseases is often difficult, as many symptoms are similar among the different diseases. To make an accurate diagnosis, a doctor may need to conduct the following:
Review the medical history
Perform a physical examination
Obtain laboratory tests, X-rays, and other imaging tests
What is involved in reviewing your medical history?
When reviewing your medical history, your doctor may ask the following questions:
Where is the pain?
How long have you had the pain?
When does the pain occur and how long does it last?
When did you first notice the pain?
What were you doing when you first noticed the pain?
How intense is the pain?
What tends to relieve the pain?
Have you had any illnesses or injuries that may explain the pain?
Is there a family history of arthritis or other rheumatic diseases?
What medication(s) are you currently taking?
What is involved in laboratory testing?
In addition to a complete medical history and physical examination, the following is a list of common laboratory tests for the diagnosis of arthritis and other rheumatic diseases, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health:
Antinuclear antibody. Measures blood levels of antibodies, which are often present in persons with rheumatic disease.
Arthrocentesis (also called joint aspiration). Obtaining a sample of synovial fluid in the joint for examination by inserting a thin, hollow needle into the joint and removing the fluid with a syringe.
Complement. Measures the level of complement, a group of proteins in the blood; low levels of complement in the blood are associated with lupus.
Complete blood count. Measures the number of white blood cells, red blood cells, and platelets present in a sample of blood; a low white blood count (leukopenia), low red blood count (anemia), or low platelet count (thrombocytopenia) are associated with certain rheumatic diseases or the medications to treat them.
Creatinine. A blood test to monitor for underlying kidney disease.
Erythrocyte sedimentation rate (also called ESR or sed rate). A measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation.
Hematocrit (PCV, packed cell volume). Measures the number of red blood cells present in a sample of blood. Low levels of red blood cells (anemia) are common in people with inflammatory arthritis and rheumatic diseases.
Rheumatoid factor. Detects whether rheumatoid factor is present in the blood (an antibody found in the blood of most, but not all, people who have rheumatoid arthritis, as well as other rheumatic diseases).
Urinalysis. Laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein; to indicate kidney disease associated with several rheumatic diseases.
White blood cell count. Measures the number of white blood cells in the blood; increased levels of white blood cells may indicate an infection, while decreased levels may indicate certain rheumatic diseases or reaction to medication.
C-reactive protein. A protein that is elevated when inflammation is found in the body. Although ESR and CRP reflect similar degrees of inflammation, sometimes one will be elevated when the other is not. This test may be repeated to test your response to medication.
Uric acid. An indication of gout.
What imaging techniques may be used to diagnose arthritis and other rheumatic diseases?
Imaging techniques may give your physician a clearer picture of what is happening to your joint(s). Imaging techniques may include the following:
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices), of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope) which is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.
Joint ultrasound. A diagnostic procedure used occasionally to find inflammation before X-rays show damage.
Bone densitometry (DEXA). An imaging study to measure bone density, used primarily to detect osteoporosis.
How is pain measured?
Measurement of pain may help your doctor find a diagnosis and determine appropriate treatment. You may be asked to describe your pain on a scale of zero to 10 and/or using certain descriptive words.