Tuesday, November 07, 2006


Tips for early identification of Rheumatoid Arthritis

As a rheumatologist I am often asked “what kind of arthritis do I have?” Clinicians divide arthritis into three categories:

 Inflammatory arthritis (e.g. Rheumatoid Arthritis, Lupus)
 Osteoarthritis (the wear and tear kind)
 Crystalline arthritis (Gout, Pseudo gout)

The reason we place patients into these categories is it helps identify the aggressiveness of the disease, and can lead to better management of the illness. The more aggressive the arthritis, the more important it is that we take action sooner rather than later.
Rheumatoid Arthritis (RA) is the most common form of inflammatory arthritis.
Approximately 1 percent of Americans have RA, which translates into 2.5 million people. In some patients the disease can be so aggressive, that joint damage can be seen by MRI’s in the first 4-6 months. The American College of Rheumatology has five clinical criteria for the diagnosis. They are:

 Morning stiffness lasting for more than 1 hour. Patients usually complain of stiffness rather than pain. They say that by the afternoon they witness a gelling phenomenon, when they start feeling pretty good. This cycle repeats itself every day. The stiffness in some patients is so severe that they do not want to get out of bed.
 Involvement of small joints of the hands and feet: RA typically involves small joints, though large joints can also be involved. The joints usually are the knuckles in the hand. The patients are usually not able to see the knuckles in the morning because of the swelling.
 Usually symmetric: The illness may start off as being asymmetric with different joints being affected on both sides of the body but, with time, most patients have the same joints involved on both sides of the body.
 Swelling and stiffness that last for at least 6 weeks in three or more joints. The reason – some patients can have a self-limiting form of arthritis that improves on its own with in 6 weeks.
 Presence of Nodules. Called rheumatoid nodules, they are commonly present on the elbows, wrist and behind the ankle joints. These are mobile early on and are boggy in consistency.

Once these signs and symptoms are identified we order lab tests and X-rays to confirm the diagnosis. Once the diagnosis is confirmed we review options for management of the disease based on the aggressiveness of the illness.
– Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center, located at the Backus Outpatient Care Center in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Varma and all of the Healthy Living columnists at healthyliving@wwbh.org

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