Master these points, no need to worry about early diagnosis of rheumatoid disease

Diagnosis of early RA

Accurate understanding of rheumatoid arthritis (RA)

and early standardized treatment

control disease progression

and key to improving RA prognosis

01 Definition of early rheumatoid

 

At present, the definition of early RA is not uniform

Some studies have suggested that early RA may be associated with a variety of autoantibodies, significant synovitis, and even bone erosion

02Clinical features of early RA

The onset is more insidious

Early-onset RA is mostly insidious and may be accompanied by systemic symptoms, such as fatigue, weight loss, and low-grade fever

Pay attention to morning stiffness and joint symptoms

Clinical features of early RA include morning stiffness, pain, swelling, tenderness, and limitation of motion in symmetrical facet joints

Commonly affected joints include the wrist, metacarpophalangeal, and proximal interphalangeal joints, and the metatarsophalangeal and interphalangeal joints of the foot; large joints such as the elbow, knee, and ankle can also be affected

Involvement of other organs cannot be ignored

In addition to joint involvement, RA can involve the skin, lungs, kidneys, salivary glands, eyes and other systemic organs, but most of them appear in advanced patients

03 Classification criteria for early RA

Be alert to risk factors

EULAR proposed the main clinical characteristics of arthralgia patients with high risk of RA, including 7 aspects (Table 1), meeting 3 or more of them, the sensitivity of high risk of RA was 90.

Early RA classification also has Chinese standards

A prospective multicenter cohort study in China for patients with disease duration less than 1 year and at least one persistent joint swelling and pain has introduced a new classification criteria for early RA, as shown in Table 2.

04Auxiliary examination assistant for early RA diagnosis

laboratory test

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used indicators to reflect the severity of inflammation.

Autoantibodies are one of the main pathogenic factors of RA and an important marker of early RA

There are anti-CCP antibodies, anti- MCV antibodies, and IgM-RF in the serum of patients with early RA , and their sensitivity and specificity are high.

radiological examination

Joint X-ray examination can only show non-specific manifestations such as swelling of soft tissue around the joint and osteoporosis of the bone end , and the value of assisting the diagnosis of RA is limited;

Ultrasound examination can find imaging manifestations including synovial hyperplasia, joint effusion, cortical bone defect and discontinuity, which can help to determine the patient's disease activity, functional activity, inflammatory lesions, and joint damage.

Color Doppler ultrasound can detect the synovial blood flow signal, and judge the degree of local synovial inflammation according to the weak blood flow signal, help to judge the disease activity and evaluate the efficacy of drugs;

MRI has a high resolution of soft tissue, and can indicate early bone marrow edema, synovitis, flexor tenosynovitis, bone erosion at the joint edge, and small cystic changes in the bone under the articular surface.

references:

Li Xue,Su Yin.

Diagnosis of early RA

Early diagnosis of RA

Accurate understanding of rheumatoid arthritis (RA)

Accurate understanding of rheumatoid arthritis (RA )

and early standardized treatment

and early standardized treatment

control disease progression

control disease progression

and key to improving RA prognosis

and key to improving RA prognosis

01 Definition of early rheumatoid

01 01 Definition of early wind-like clearance

 

At present, the definition of early RA is not uniform

At present, the definition of early RA is not uniform

Some studies have suggested that early RA may be associated with a variety of autoantibodies, significant synovitis, and even bone erosion
.
Therefore, accurate understanding of the disease and early standardized treatment are the keys to controlling the development of the disease and improving the prognosis of RA
.
With the continuous improvement of the level of RA classification and diagnosis, the definition of early RA will also change
.

02Clinical features of early RA

02Clinical features of early RA02 02Clinical features of earlyRA

The onset is more insidious

The onset is more insidious

Early-onset RA is mostly insidious and may be accompanied by systemic symptoms, such as fatigue, weight loss, and low-grade fever
.

Early-onset RA is mostly insidious and may be accompanied by systemic symptoms, such as fatigue, weight loss, and low-grade fever
.

Pay attention to morning stiffness and joint symptoms

Pay attention to morning stiffness and joint symptoms

Clinical features of early RA include morning stiffness, pain, swelling, tenderness, and limitation of motion in symmetrical facet joints
.

Clinical features of early RA include morning stiffness, pain, swelling, tenderness, and limitation of motion in symmetrical facet joints
.

Commonly affected joints include the wrist, metacarpophalangeal, and proximal interphalangeal joints, and the metatarsophalangeal and interphalangeal joints of the foot; large joints such as the elbow, knee, and ankle can also be affected
.
In addition, temporomandibular joints, cricoarytenoid joints, sternoclavicular joints, and intervertebral disc joints are occasionally involved
.

Commonly affected joints include the wrist, metacarpophalangeal, and proximal interphalangeal joints, and the metatarsophalangeal and interphalangeal joints of the foot; large joints such as the elbow, knee, and ankle can also be affected
.
In addition, temporomandibular joints, cricoarytenoid joints, sternoclavicular joints, and intervertebral disc joints are occasionally involved
.

Involvement of other organs cannot be ignored

Involvement of other organs cannot be ignored

In addition to joint involvement, RA can involve the skin, lungs, kidneys, salivary glands, eyes and other systemic organs, but most of them appear in advanced patients
.

In addition to joint involvement, RA can involve the skin, lungs, kidneys, salivary glands, eyes and other systemic organs, but most of them appear in advanced patients
.

03 Classification criteria for early RA

03 03 Classification criteria for early RA

Be alert to risk factors

Be alert to risk factors

EULAR proposed the main clinical characteristics of arthralgia patients with high risk of RA, including 7 aspects (Table 1), meeting 3 or more of them, the sensitivity of high risk of RA was 90.
2%, and the specificity was 74.
4%; If 4 or more of them are satisfied, the sensitivity of high risk of RA is 70.
5%, and the specificity is 93.
6%
.

EULAR proposed the main clinical characteristics of arthralgia patients with high risk of RA, including 7 aspects (Table 1), meeting 3 or more of them, the sensitivity of high risk of RA was 90.
2%, and the specificity was 74.
4%; If 4 or more of them are satisfied, the sensitivity of high risk of RA is 70.
5%, and the specificity is 93.
6%
.

Early RA classification also has Chinese standards

Early RA classification also has Chinese standards

A prospective multicenter cohort study in China for patients with disease duration less than 1 year and at least one persistent joint swelling and pain has introduced a new classification criteria for early RA, as shown in Table 2.
Meeting 3 or more of the 5 criteria is Classifiable diagnosis of early RA
.

A prospective multicenter cohort study in China for patients with disease duration less than 1 year and at least one persistent joint swelling and pain has introduced a new classification criteria for early RA, as shown in Table 2.
Meeting 3 or more of the 5 criteria is Classifiable diagnosis of early RA
.

04Auxiliary examination assistant for early RA diagnosis

04 04 Auxiliary examination assistant for early RA diagnosis

laboratory test

laboratory test

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used indicators to reflect the severity of inflammation.
In the early stage of disease activity, RA can be significantly increased, and it can be reduced to normal after disease remission.
It is one of the reference indicators for clinical judgment of RA disease activity.
one
.

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are commonly used indicators to reflect the severity of inflammation.
In the early stage of disease activity, RA can be significantly increased, and it can be reduced to normal after disease remission.
It is one of the reference indicators for clinical judgment of RA disease activity.
one
.
Erythrocyte sedimentation rate C-reactive protein

Autoantibodies are one of the main pathogenic factors of RA and an important marker of early RA
.
Currently the most clinically tested are  RF  and  ACPA
.

Autoantibodies are one of the main pathogenic factors of RA and an important marker of early RA
.
Currently the most clinically tested are  RF  and  ACPA
.
Autoantibody RF ACPA

There are anti-CCP antibodies, anti- MCV antibodies, and IgM-RF in the serum of patients with early RA , and their sensitivity and specificity are high.
Early diagnosis rate
.
The determination of serum MMP3 level has an auxiliary evaluation value for early rheumatoid arthritis patients with normal CRP and/or ESR disease course less than 2 years
.

There are anti-CCP antibodies, anti- MCV antibodies, and IgM-RF in the serum of patients with early RA , and their sensitivity and specificity are high.
Early diagnosis rate
.
The determination of serum MMP3 level has an auxiliary evaluation value for early rheumatoid arthritis patients with normal CRP and/or ESR disease course less than 2 years
.
Anti-CCP MCV antibody, IgM-RF MMP3

radiological examination

radiological examination

Joint X-ray examination can only show non-specific manifestations such as swelling of soft tissue around the joint and osteoporosis of the bone end , and the value of assisting the diagnosis of RA is limited;

Joint X-ray for osteoporosis

Ultrasound examination can find imaging manifestations including synovial hyperplasia, joint effusion, cortical bone defect and discontinuity, which can help to determine the patient's disease activity, functional activity, inflammatory lesions, and joint damage.
Assist in the early diagnosis of RA;

Ultrasonography

Color Doppler ultrasound can detect the synovial blood flow signal, and judge the degree of local synovial inflammation according to the weak blood flow signal, help to judge the disease activity and evaluate the efficacy of drugs;

Color Doppler Ultrasound

MRI has a high resolution of soft tissue, and can indicate early bone marrow edema, synovitis, flexor tenosynovitis, bone erosion at the joint edge, and small cystic changes in the bone under the articular surface.
The MRI findings of the metacarpophalangeal and wrist joints have more diagnostic value
.
The EULAR recommendation on the use of imaging in early RA states that joint ultrasound or MRI is superior to clinical physical examination in detecting synovial inflammation and superior to X-ray in detecting bone destruction
.

MRI

references:

Li Xue,Su Yin.
Diagnosis and treatment of early rheumatoid arthritis[J].
Chinese Journal of Internal Medicine,2020,59(9):724-727.
DOI:10.
3760/cma.
j.
cn112138-20200703-00644.

Li Xue,Su Yin.
Diagnosis and treatment of early rheumatoid arthritis[J].
Chinese Journal of Internal Medicine,2020,59(9):724-727.
DOI:10.
3760/

cma.
j.
cn112138-20200703-00644.
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