Arthritis Diagnosis
How Doctors Diagnose Arthritic Pain

Arthritis Diagnosis

Contents

• How is Arthritis Diagnosed?
• What Happens In A Medical Examination?
• What Do Blood Tests Reveal?

Overview of Joints
Guide to Arthritis

How is Arthritis Diagnosed?

A doctor will often be able to diagnose arthritis by a patient's history and specific symptoms. A physical examination of the joints will be carried out and certain blood tests are useful for distinguishing the various types of arthritis. Fluid surrounding the joints can be extracted with a needle and sent to a laboratory for diagnosis. An X-ray or MRI scan may be carried out to see the extent of joint damage. If septic/infectious arthritis is suspected, for example resulting from gonorrhea, a culture sample will be taken from the cervix for analysis. Any swelling or joint stiffness occurring from an infection needs to be treated promptly to avoid permanent joint damage.

What Can I Expect In The Medical Examination?

A comprehensive medical history; discussion of any potential symptoms of arthritis including pain, stiffness and swelling; and a physical examination of the affected areas.

Medical History

Discussion of your medical history, allergies and any medications you may be taking.

Pain

Your doctor will discuss the history of the pain, when it started and have you noticed any triggers (such as certain movements or foods causing a flare up - see causes of arthritis).

1. Have there been any past traumas which may have caused joint damage or infection? This is a common cause of arthritis of the knee.
2. Is pain acute (severe) occurring almost instantly, as with gout, or gradually over years, as with osteoarthritis?
3. Is pain worse in the morning and at the end of the day? This is an indication of inflammatory pain, as in the case of rheumatoid arthritis.
4. Is pain worse with use of joints and activity? This is known as mechanical pain, and more consistent with osteoarthritis.
5. Is pain diffused, or described as 'all over'? All over pain is often associated with fibromyalgia and fibromyalgia tender points.

Stiffness

How long stiffness lasts is proportional to the advancement of the disease and how much inflammation there is. Degenerative arthritis like osteoporosis is associated with stiffness and occasional swelling first thing in the morning and after periods of inactivity. The stiffening of joints is known as 'gelling'. With inflammatory diseases like rheumatoid arthritis, stiffness and swelling of joints occurs in the morning but lasts for longer, an hour or more. Polymyalgia rheumatica (PMR) is also associated with morning stiffness but more specifically of the shoulder, neck, buttocks and thighs.

Fatigue

Extreme tiredness is more associated with inflammatory arthritis and fibromyalgia pain. Morning and midday fatigue is a common complaint of people suffering from rheumatoid arthritis, while fibromyalgia patients tend to feel tired on a constant basis.

Cracking Of Joints

A cracking, popping or creaking sound coming from the joints is not necessarily an indication of arthritis. A study showed that those who cracked their fingers and knuckles regularly showed no increased risk of developing arthritis of the hand. The phenomenon is little understood. Some arthritic patients do notice cracking sounds with joint movement but this is considered unharmful and does not damage the joints.

Feeling Of General Wellness

Your doctor will ask about how you are generally feeling:
1. Any weight loss?
2. Loss of appetite?
3. Fever?
4. Skin rashes?
5. Eye problems, such as red eye or dry eye? (Rheumatic diseases can affect the eye). This will also help rule out any other underlying conditions.

Interesting: Natural Treatment for Arthritis
Alternative techniques for reducing the symptoms of arthritis, or see books on arthritis for self-help guides.

The Physical Examination

The initial goal of a physical examination is to identify the source of pain. The doctor will probe all the joints and examine the tissue around them. He will look for signs of:

1. Swelling.
2. Redness in joints or tendons.
3. Spongy texture around the joints which indicates fluid associated with swelling
4. Skin changes, such as rashes, psoriasis, or Raynaud’s phenomenon which causes discoloration of fingers and toes.
5. Bone deformities.

The doctor will also test movement of the joints using one or all of 3 techniques:

Active Movement: This is where the patient moves her own muscles through a range of motions.
Passive Movement: The patient relaxes while the doctor moves the muscles. This helps to locate the exact location of pain which may have been felt during an active movement.
Resisted Movement: The patient resists pressure applied by the examiner. This helps to locate the exact tendon or bursa where pain is coming from.

Once a complete history and examination has been carried out, this will provide the main information for making a diagnosis. Blood tests and a scan usually complete the diagnosis, particularly if the disease is in its early stages, and has less obvious physical symptoms. With the advancement of imaging techniques, early changes to muscle and bone are visible on a MRI Scan which would still be seen as 'normal' on X-Rays.

What Do Blood Tests Show?

Blood tests are often used to confirm a doctor's diagnosis. What might a blood test reveal?

Rheumatoid Factor: An antibody which is found in the blood and is present in nearly 80 percent of people with rheumatoid arthritis. It can still be present in people without the disease but usually only where a family member has the condition.
Anti-cyclic Citrullinated Peptide Antibody Test (Anti-CCP): More commonly used where rheumatoid arthritis is suspected, as it is even more specific than rheumatoid factor. High levels indicate the presence of the disease.
Erythrocyte Sedimentation Rate (ESR): This shows how much inflammation is present in the body. In a healthy person ESR is low, in a person with arthritis the levels increase according to the severity of inflammation.
C-reactive Protein (CRP): Another measure of inflammation, levels go up the more inflammation is present.
Uric Acid: Levels will be high in patients who suffer gout attacks.
Joint Fluid: The doctor might use a needle to extract some fluid from around the joints for testing. This fluid can give an indication as to the health of the joint.

Related Articles on Arthritis

For more issues, see the following:

• Diagnosis of rheumatoid arthritis: The RA criteria test.
• Osteoarthritis diagnosis: Tests and medical exam explained.
• Arthritis equipment: Useful tools for making life easier.

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