Diagnosis
Comments 2

How the docs diagnose RA

Going up- Going down RA at it's finest.

Going up- Going down
RA at it’s finest.

The course of RA is unique to each of us.  My RA announced itself  to me as  big and boisterous.  Initially, I had sharp pain in my left shoulder.  I thought it was from swimming as shoulders do get a workout in lap swimming.  Quickly hands, fingers, wrists, ankles, feet and toes joined in.  I was in total pain and largely incapacitated.  I sought salvation to my problem in the ER, the only solution at the time.

In 2010 the American College of Rheumatology(ACR) and the European League Against Rheumatism(EULAR) formed a working group to replace the 1987 ACR classification criteria for RA with up to date classification criteria.

RA is at its most destructive in the first 2 years.  It needs to be caught early and treated aggressively.  The 2010 Rheumatoid Arthritis Classification Criteria became a big diagnostic help.

The group came up with a 10 point system that covers four RA categories:  joint involvement, serology, acute-phase reactants, duration of symptoms.  The target population for this scoring must be patients who have at least 1 joint with definite clinical synovitis(swelling) that cannot be explained by another disease.

There could be a total of 10 points. 6 points would confirm the RA diagnosis.

A.    Joint involvement                                                                                  Points

1.  One large joint                                                                                       0                                                    2.  2-10 large joints                                                                                     1                                                   3.  1-3 small joints                                                                                       2                                                  4.  4-10 small joints                                                                                     3                                                  5.  > 10 joints( at least one small joint)                                                    5

B.  Serology

1.  Negative RF and negative  ACPA                                                            0                                               2.  Low positive RF or low positive ACPA                                                    2                                               3.  High positive RF or high positive ACPA                                                 3

C.  Acute-phase reactants

1. Normal CRP and normal ESR                                                                    0                                              2. Abnormal CRP or abnormal ESR                                                              1

D.  Duration of symptoms

1.     < 6 weeks                                                                                                  0                                             2.     > 6 weeks                                                                                                  1

My score

A   Many more than 10 small joints                                                                      5

B    Serology negative                                                                                               0

C.   Acute-phase reactants off the charts both ESR and CRP                             1

D.  Duration of symptoms > 6 weeks                                                                      1

 

My score is 7 and a firm diagnosis for RA.  I met the greatest rheumatologist in the world within two weeks of my ER visit.  In another month I would have started the drug methotrexate.  Presently, I have full blown and seriously progressing RA. This 2010 criteria was right on for me.

For more information on it, Google it. An article that I like is:

2010 Rheumatoid Arthritis Classification Criteria, ARTHRITIS AND RHEUMATISM, Vol.62, No 9, September 2010, pp2569-2581. There is a long list of authors starting with Daniel Aletaha and ending with Frederick Wolfe and Gillian Hawker.

 

2 Comments

  1. My RA started in a wrist that soon included the other wrist. My GP was treating the first wrist as a sprain (car door yank by the wind) but started blood work as soon as the other started doing the same thing without any provocation. I had a very high RF and sed rate. He said it was RA and booked an appointment for me in the city with a rheumotologist. (way too far in the future for sure!) He confirmed the diagnosis. The GP had put me on MTX and an anti-inflammatory. By the time I saw the specialist, my hands, feet, ankles and elbows had joined the party. I didn’t start getting full relief until I started Enbrel. I put off doing a biologic because of the scary disclaimers. If I didn’t think it was helping me, I know now that it is tremendously. A recent surgery required being off the biologic for 3 weeks. I could barely walk across the floor before I could resume the meds. I thankfully do my injections. I don’t know where I would be without them. This is a progressive disease. I think back and can remember little instances that foreshadowed full RA at least 10 years before it got bad enough to check out. I hope you can find something to help you slow it down. It takes the perfect “cocktail” just for you.

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