Laboratory tests of blood and urine are informative diagnostic measures that are performed to detect arthritis and determine its type. Clinical studies can detect changes in the quantitative composition of red blood cells, platelets, white blood cells. Biochemical blood tests are performed to determine the level of sialic and uric acids, proteins produced by the body during a strong inflammatory process. Enzyme-linked immunosorbent assay is testing specific markers to detect antibodies – diagnostic criteria for rheumatoid, reactive arthritis.
When diagnosing, doctors take into account the results of feces and urine tests. Their parameters make it possible not only to differentiate arthritis from other pathologies, but also to discover the cause of some diseases, for example, chlamydial urogenital infection.
- Synovial fluid analysis
- General blood analysis
- Serological blood tests
- Biochemical blood tests
- What does laboratory analysis for rheumatoid arthritis show?
- Rheumatoid arthritis: laboratory diagnosis of the disease
- General blood analysis
- Rheumatoid factor
- Antistreptolysin O
- Biochemical analysis of blood
- Antibodies to cyclic citrulline peptide (ADC)
- Antinuclear antibodies
- Arthrosis tests
- Laboratory examination for joint pain
- Methods for the diagnosis of joint diseases: purpose and features of procedures
- Competent diagnosis of joint diseases is the key to treatment effectiveness
- General examination and palpation method
- Laboratory diagnostic methods
- Joint Radiation Diagnostics
- Joint MRI
- Ultrasound examination of joints
- What research method to choose?
- Tests for arthrosis of the knee
- Blood test
- Magnetic resonance therapy
- Computed tomography
- What tests are indicated for rheumatoid arthritis?
- The clinical picture of arthrosis
- What you should pay attention to
- Briefly about the diagnosis
- Symptoms that confirm the development of RA
- What can biochemical analysis say?
- Signs of RA on an X-ray
- Changes in blood counts with arthrosis
- Synovial fluid examination
- disease prevention
Synovial fluid analysis
A synovial fluid sample is obtained during puncture – puncture of the joint bag with special tools. His research often reveals the origin of the pathology. If blood impurities and / or small fragments of hyaline cartilage are found in the synovia, the doctor suggests the development of post-traumatic arthritis in the patient.
If purulent exudate is contained in the synovial fluid, then further studies are carried out to establish the causes of its appearance, for example, pathogenic microorganisms. The presence of uric acid crystals in the synovia indicates a severe course of gout.
General blood analysis
In the process of research, changes in the quantitative composition of red and white blood cells are detected. An increased level of leukocytes directly indicates the course of the inflammatory process in the patient’s body. By this criterion, one can indirectly judge its intensity. The more leukocytes in the systemic circulation compared with the norm, the stronger the inflammation.
Another of the most informative methods of laboratory diagnostics is the erythrocyte sedimentation rate. Normally, ESR does not exceed 15 mm / h in women, 10 mm / h in men. If a pathology develops in the body, then its intermediate and final products are present in the blood. They are firmly attached to red blood cells, making them heavier. Therefore, the sedimentation rate of red blood cells to the bottom of the tube increases. The value of ESR also allows us to judge the severity of the pathology. With indicators above 4,0 * 109 / l, the doctor may suggest that the patient has:
- lupus erythematosus;
- rheumatoid arthritis.
In these autoimmune diseases, the ESR criterion is closely related to the degree of activity of the inflammatory process.
With the development of any type of arthritis in the bloodstream, a slight decrease in the level of red blood cells is observed (3,7 * 1012 / L in women and 4,5 * 1012 / L in men). The amount of hemoglobin, which is capable of reversibly binding with oxygen, is also reduced, ensuring its transfer to the tissue. Rheumatoid, reactive, infectious arthritis is characterized by its decrease of less than 120 g / l and the detection of monochrome, hypochromic, normocytic, microcytic anemia. Much less frequently, the course of the pathology is accompanied by iron deficiency, aplastic or hemolytic anemia.
With rheumatoid arthritis, the combination of clinical and hematological syndromes is more common, but with a reactive disease the severity of signs of anemia is somewhat stronger. This is due to the high level of mediators of cytokines produced in response to an acute inflammatory process.
|Laboratory tests for arthritis||Name of research|
|Urinalysis||It is carried out to differentiate arthritis from other pathologies. Most arthritis is characterized by normal values. With systemic lupus and scleroderma, kidneys are damaged, so blood, glucose, and proteins (more than 0,14 g / l) are found in urine. Low uric acid (less than 0,27 g / day) is a sign of gout|
|Sowing a biological sample taken from the urethra||Sowing is carried out in a nutrient medium with suspected development of chlamydial arthritis. By the number of colonies formed, the intensity of the inflammatory process provoked by pathogenic microorganisms can be established|
Serological blood tests
In the process of serological blood tests, rheumatoid factor (RF) is qualitatively determined. This is not the most informative criterion for rheumatoid arthritis, since approximately the same values are characteristic for lupus erythematosus and scleroderma. But an increase in the level of rheumatoid factor of more than 10 units / ml with a high probability indicates the development of a still final incurable type of arthritis. RF – immunoglobulins produced by the synovial membrane to attack the body’s own cells. This happens only with the development of autoimmune pathologies, which include rheumatoid arthritis.
The principle of detecting abnormal antibodies is based on their ability to interact with Fc fragments of immunoglobulins. In the blood of a healthy person, the presence of a certain amount of RF (less than 10-20 U / ml) is permissible, which remains after the infectious diseases.
Even “neglected” joint problems can be cured at home! Just remember to smear it once a day.
In laboratories, the rheumatoid factor is determined in qualitative and quantitative terms, and in different institutions the parameters obtained may differ slightly due to the use of various reagents and equipment. For high-quality detection, latex testing or the Waaler-Rose reaction is performed. The quantity can be determined by the results of nephelometric or turbidimetric studies. But lately, preference has been given to ELISA – enzyme-linked immunosorbent assay, detecting RF and other pathological immunoglobulins.
Any autoimmune reaction is accompanied by the production of antinuclear antibodies that attack the protein nuclei of articular cells. Therefore, when they are detected in the blood, the doctor suspects the development of reactive or rheumatoid arthritis. If in the clinical analysis the erythrocyte sedimentation rate is high, then this becomes an indication for detecting the level of antinuclear antibodies. The diagnostic marker is not specific, since its high values are characteristic of other diseases:
- various forms of hepatitis.
With high reliability, the development of rheumatoid arthritis is indicated by the high parameters of ADC (anticytrulline antibodies). They are produced by the immune system in response to the discovery of cyclic citrulline peptides that are similar in chemical structure to the amino acid contained in the protein molecules of the synovial capsule. The accuracy of this diagnostic criterion is more than 90%.
Biochemical blood tests
Biochemical tests for arthritis help determine the cause of its development. Be sure to determine the level of uric acid. Its increased values at a rate of up to 5,8 mg / dl suggest that the patient has gout occurring against the background of accumulation of uric acid salts in the joints and kidneys. A high content of urea in the systemic circulation is detected during gouty attacks. The levels of creatinine (the final product of the creatine-phosphate reaction) and urea (the final product of protein metabolism) are established. If the parameters are respectively higher than 110 μmol / L and 7,5 mmol / L, then this indicates damage to the kidney structures characteristic of systemic pathologies, or secondary gout.
Biochemical components found in the bloodstream can become a marker of the inflammatory process and its intensity. For example, during exacerbation of rheumatoid arthritis, a high level of haptoglobin is detected. The appearance of this protein indicates the destruction of a large number of red blood cells. In the process of biochemical studies, quantitative values of the following components are also established:
fibrinogen is a specific plasma protein in dissolved form. When blood coagulates, it is from it that blood clots form. In people with rheumato >
A C-reactive protein is also detected, which refers to acute phase proteins. The concentration of such proteins is always high with severe inflammation. Its detection suggests the presence of infectious, reactive, rheumatoid arthritis in the patient.
C-reactive protein is intensely produced by the immune system in response to the introduction of pathogenic bacteria or allergic agents into the body. Establishing its amount allows us to differentiate arthritis from arthrosis, which are not accompanied by intense inflammation. The level of C-reactive protein is not a specific diagnostic marker of arthritis of autoimmune or infectious origin. But its increase is almost always observed with systemic pathologies that affect the joint structures simultaneously or sequentially with internal organs.
What does laboratory analysis for rheumatoid arthritis show?
Rheumatoid arthritis is an autoimmune disease, due to which inflammatory processes actively develop in the connective tissue. The disease is severe and often leads to disability. What tests are given for arthritis and does it help to identify an ailment in the early stages? For laboratory tests, the patient’s blood is needed. It is subjected to biochemical analysis, the hemoglobin level is measured and the number of formed elements (red blood cells, white blood cells, platelets) is counted. Characteristic changes in the blood appear already at the beginning of the second month of the disease, so laboratory diagnosis is an effective way to early detection of an ailment.
Rheumatoid arthritis: laboratory diagnosis of the disease
How to diagnose arthritis? There are characteristic signs, the presence of at least 4 of which indicate this disease. The following are the diagnostic criteria for rheumatoid arthritis:
- morning stiffness, lasting more than 1 hour after waking up;
- involvement of at least 3 joints in the process;
- seals in the form of nodules on the skin in the area of bone protrusions;
- primary damage to small joints;
- the presence of rheumatoid factor in the blood;
- symmetry of pathology;
- x-ray changes.
At an early stage, the disease can manifest itself only with weakness and mild morning stiffness, so people do not seek help from a doctor. X-rays may still not have pathological changes, and a blood test can suspect a disease even after 6 weeks from its onset. For an objective result, all tests are performed on an empty stomach.
General blood analysis
In a general blood test (KLA), such pathological changes are possible:
- increased erythrocyte sedimentation rate (ESR);
- decreased hemoglobin;
- increased white blood cell count.
An increase in ESR and an increase in the number of leukocytes is the result of an acute inflammatory process. The normal ESR is 2-15 mm / hour, and in patients this indicator is usually not less than 25 mm / hour (depending on the severity and period of the disease). In a healthy person, the number of leukocytes in the KLA ranges from 4000-9000, but in patients with rheumatoid arthritis there is a slight increase in this indicator.
The norm of hemoglobin in women is 120-140 g / l, in men – 135-160 g / l. A decrease in numbers indicates anemia, which develops in patients who have long been suffering from rheumatoid arthritis. This is due to the shortening of the life cycle of red blood cells and metabolic disorders.
Rheumatoid factor (RF) is an antibody produced in response to its own cells, which due to the disease are perceived as foreign. RF is determined in the blood not only with diseases of the musculoskeletal system, it is also formed with viral and bacterial infections, liver damage, and malignant tumors. The norm in healthy people is 0-14 IU / ml.
An increase in RF occurs in 60% of cases. There are also seronegative forms of arthritis, in which this indicator remains unchanged. The Russian Federation is dangerous in that it forms insoluble complexes. They are deposited on the walls of blood vessels, which leads to a violation of the blood supply to tissues and the development of vasculitis.
Antistreptolysin O (ASLO) is an antibody that appears when a streptococcal infection develops in the body. Basically, they increase due to hemolytic streptococcus group A, which causes rheumatism.
This indicator is used to clarify the diagnosis and helps distinguish rheumatism from rheumatoid arthritis. In the first case, ASLO increases significantly, and in the second, it remains unchanged or increases insignificantly.
The norm of ASLO value in an adult is up to 200 units / ml, in children under 16 years of age – up to 400 units / ml. It rises with reactive arthritis. This is an inflammatory process in the joints caused by a primary infection with localization in other organs.
Causes of reactive arthritis can be intestinal infections, sexually transmitted diseases, reproduction of pathogenic bacteria in ENT organs, etc.
Biochemical analysis of blood
In a biochemical analysis with this disease, such changes may appear:
- increased sialic acid levels;
- an increase in the amount of fibrinogen;
- high content of C-reactive protein.
Sialic acids increase due to the inflammatory process in the connective tissue. In healthy people, they are contained in the blood at a concentration of 2-2,33 mmol / L. An increase in their level may indicate rheumatoid arthritis or polyarthritis of another etiology.
Fibrinogen is a protein involved in blood coagulation processes. Normally, its amount does not exceed 2-4 g / l, but with rheumatoid inflammation of the joints its content increases. A high level of fibrinogen is dangerous by the formation of blood clots in the vessels, which interfere with the normal flow of blood and can cause ischemic changes in various organs.
The content of C-reactive protein rises in the blood in any inflammatory process. In the acute period of rheumatoid arthritis, its value reaches 400 mg / l and higher. The higher this indicator, the harder the pathological process proceeds. Normally, C-reactive protein is present in an amount of 0-5 mg / L in the blood.
Antibodies to cyclic citrulline peptide (ADC)
ADCs are substances that the body produces during autoimmune reactions that occur in the body with rheumatoid arthritis. In this case, the body perceives its own tissues as foreign, and secrete antibodies to combat them.
These antibodies are present in the blood even with seronegative types of the disease. This is very important for establishing the correct diagnosis, because in this case the rheumatoid factor is not determined in the blood.
The value of this analysis is that it helps to identify the earliest forms of the disease. ADCs form in the blood about 12 months before the onset of the first severe symptoms.
The rate of ADC is from 0 to 3 units / ml. The analysis is used to make a diagnosis, but not to assess the course of the disease in dynamics. This is due to the fact that when the patient worsens, the ESR, leukocyte and hemoglobin levels change, and the level of ACCP remains the same as at the beginning of the development of the pathological process.
Antinuclear (antinuclear antibodies or ANA) are the body’s antibodies produced by it against the components of the nuclei of cells of their own tissues. The analysis is often used to diagnose systemic lupus erythematosus. But in about 10% of patients with rheumatoid arthritis, the results of this analysis are positive.
Arthrosis is a chronic disease of the joints, leading to their destruction. The processes of inflammation with this ailment are not so pronounced, they progress over a long period of time. And although some symptoms are similar to the manifestations of rheumatoid arthritis (pain, stiffness and swelling), these diseases are significantly different.
In the biochemical analysis of blood with arthrosis there are no characteristic changes, unlike arthritis, in this case, markers of inflammation are not detected.
The general blood test in most cases remains unchanged. The processes are slow, sluggish and do not have acute symptoms, so ESR and white blood cell count are within normal limits. An increase in these indicators is possible only if large joints are involved in the process, where a large area of inflammation develops, because of which a person suffers from severe pain.
For differential diagnosis, in addition to laboratory tests, X-ray, MRI and endoscopic examination methods are used.
Research results should be evaluated by a qualified doctor who takes into account the patient’s complaints, objective examination data and the results of instrumental examinations. But to have an idea about what tests are given for arthritis does not hurt anyone, because the disease can occur in any person, and the causes of its occurrence have not yet been precisely studied.
Laboratory examination for joint pain
A comprehensive examination includes tests aimed at determining circulating autoantibodies and various biochemical markers of the acute phase of inflammation. Joint pain can be a sign of arthritis, including rheumatoid, arthrosis, osteoarthrosis, gout, chondrocalcinosis, ankylosing spondylitis and other diseases. Allows you to identify a possible cause, as well as to differentiate various forms of arthritis.
What tests are included in this complex:
· Clinical blood test (with leukocyte formula);
Erythrocyte sedimentation rate (ESR);
Seric uric acid
· C-reactive protein, quantitatively (method with normal sensitivity);
Rheumatoid factor (RF);
· Antinuclear factor on HEp-2 cells;
· Antibodies to extractable nuclear antigen (ENA-screen).
What biomaterial can be used for research?
· Flow cytofluorimetry: Clinical blood test (with leukocyte formula);
· Method of capillary photometry: ESR;
· Clotting method (detection of lateral light scattering, determination of percent by endpoint): Fibrinogen;
· Immunoturbidimetry: Antistreptolysin O, C-reactive protein, Rheumatoid factor;
· Enzymatic colorimetric method: Uric acid;
· Indirect immunofluorescence reaction: Antinuclear factor on HEp-2 cells;
Enzyme-linked immunosorbent assay: Antibodies to extractable nuclear antigen (ENA-screen).
How to prepare for the study?
- During the day before the study, do not drink alcohol, as well as medications (as agreed with the doctor);
- Do not eat for 12 hours before analysis;
- Eliminate physical and emotional stress within 24 hours before the study;
- Do not smoke 3 hours before the test.
Joint pain can be a sign of arthritis, including rheumatoid, arthrosis, osteoarthritis, gout, chondrocalcinosis, ankylosing spondylitis and other diseases.
Joint inflammation can also be caused by infectious or systemic diseases: influenza, scarlet fever, tuberculosis, gonorrhea, chlamydia, as well as a chronic focus of infection caused by staphylococci or streptococci. At the heart of many joint diseases is the inflammatory process, which becomes the cause of mobility disorders from the musculoskeletal system.
Inflammation is a biochemical protective reaction of the body in response to tissue damage, can be both acute and chronic. So, for example, in rheumatoid arthritis, the process of systemic chronic inflammation is accompanied by an increase in the erythrocyte sedimentation rate (ESR) and in the concentration of such acute phase proteins as fibrinogen and C-reactive protein. Fibrinogen is one of the factors known as rheumatic tests. Fibrinogen levels increase sharply in the blood with inflammation or tissue damage.
Antistreptolysin-O is one of the laboratory markers of rheumatism, it is used for the differential diagnosis of rheumatism and rheumatoid arthritis (in the case of RA, the level of antistreptolysin-O is much lower). An increase in this indicator indicates the sensitization of the body to streptococcal antigens.
Elevated uric acid is one of the signs of gout, rheumatism, arthritis and other disorders. If the rate of synthesis of uric acid exceeds the rate of its excretion from the body, the process of purine metabolism is disrupted. The delay of this substance in the body affects the activity of the kidneys, kidney failure develops, leading to inflammation of the joints, in which crystals of uric acid are deposited in the joint (synovial) fluid.
Rheumatoid factor (RF) is included in the list of standard criteria for rheumatoid arthritis established by the American Association of Rheumatology (AAR). It is determined in 75-80% of patients with rheumatoid arthritis, however, it is not specific for rheumatoid arthritis, but indicates the presence of suspicious autoimmune activity. It is also found in Sjögren’s syndrome, scleroderma, dermatomyositis, hyperglobulinemia, B-cell lymphoproliferative diseases. About 30% of patients with systemic lupus erythematosus (SLE) without signs of rheumatoid arthritis are RF-positive. The sensitivity of the Russian Federation to rheumatoid arthritis is only 60-70%, and the specificity of 78%.
Rheumatoid factor is an antibody against immunoglobulin class G fragments (IgG). More often (up to 90% of cases), these antibodies belong to class M immunoglobulins (IgM), IgG, IgA, IgE are rare. Despite the low specificity, the presence of RF is considered an important prognostic sign for the outcome of rheumatoid arthritis.
Antinuclear antibodies (another name is the antinuclear factor) is a heterogeneous group of antibodies that react with various components of the cell nucleus. A healthy person with normal immunity should not have antinuclear antibodies in the blood or their level should not exceed the established reference values. The loss of a number of readily soluble components from the nucleus of HEP-2 cells (standardized cells that are used in the analysis) or their redistribution to the cytoplasm may cause the detection of low titers of antinuclear factor on the Hep-2 cell line.
It is advisable in conjunction with the determination of the antinuclear factor to use the determination of the specificity of antinuclear antibodies, which avoids false negative results in systemic rheumatic diseases. By the definition of “specificity of antinuclear antibodies” is meant the definition of autoantibodies to specific antigens, for which the definition of extractable nuclear antigen (ENA-screen) is used. ENA is a readily soluble component of the cell nucleus. This test includes antigens RNP-70, RNP / Sm, SS-A, SS-B, Scl-70, centromeric protein B and Jo-1, and a number of them are obtained by the recombinant method.
Due to the high sensitivity of 95-98%, the combined use of two tests allows both early diagnosis of systemic diseases and clarification of the diagnosis of systemic disease with an unclear clinical picture.
The specificity of ENA-screening is somewhat inferior to the specificity of the study on antibodies of the ENA group using the immunoblot method. This fact is of particular importance in the case of examination of individuals with suspected presence of systemic lupus erythematosus, as well as mixed connective tissue disease. With this in mind, with a positive result of ENA-screening, an additional confirmatory study is performed – immunoblot.
The detection of antibodies indicates the presence of an autoimmune disorder, but does not indicate a specific disease, since the test is a screening study. The purpose of any screening is to identify people with an increased risk of a particular disease.
What is the study used for?
- Differential diagnosis of arthritis;
- Diagnosis of systemic autoimmune diseases;
- For the diagnosis of rheumatoid arthritis and Sjogren’s syndrome, as well as to distinguish them from other forms of arthritis and diseases with similar symptoms.
When is the study scheduled?
- With symptoms of an autoimmune disease (prolonged fever, joint pain, fatigue, weight loss, change in skin integument);
- When identifying changes characteristic of systemic diseases of the connective tissue (increased ESR, C-reactive protein levels, circulating immune complexes);
- With rheumatoid arthritis (determination of the activity of the process, prognosis and control of treatment of the disease);
- If gout is suspected (the main symptom is pain in the joints, most often in the big toe);
- In the presence of morning stiffness or stiffness of the joints.
What do the results of the study mean?
For the diagnosis it is important to use a comprehensive examination, which includes laboratory diagnostics, clinical data and modern methods of instrumental examination of the joints: CT, MRI, ultrasound.
Clinical blood test (with leukocyte formula)
Reference values: decoding of a general blood test (see detailed description)
The leukocyte formula is usually interpreted depending on the total number of leukocytes. If it deviates from the norm, then focusing on the percentage of cells in the leukocyte formula can lead to erroneous conclusions. In these situations, the assessment is made on the basis of the absolute number of each type of cell (in a liter – 10 12 / l – or microliter – 10 9 / l).
Methods for the diagnosis of joint diseases: purpose and features of procedures
Joint diseases do not begin overnight – the resulting pain suggests that the disease has already reached a certain stage. How to monitor the condition of the joints in order to detect a deviation from the norm in time and start treatment immediately? Let’s figure it out.
Competent diagnosis of joint diseases is the key to treatment effectiveness
Joint pain can be a signal of arthritis, including rheumatoid, arthrosis, osteoarthritis, bursitis, chondrocalcinosis, ankylosing spondylitis and other diseases. The following symptoms are usually indicated by the symptoms listed below.
The appearance of pain in the knees during the ascent or descent of the stairs may signal osteoarthritis. This disease sometimes affects the fingers, too – in this case, the upper phalanges are densified. Unexpected sharp pain in the big toe is a typical signal of arthritis. This disease often affects the hip joints and makes itself felt with severe pain in the upper leg. Rheumatoid arthritis can occur in violation of fine motor skills of the hands, when it becomes difficult to insert the key into the lock or thread in the needle.
Unfortunately, today 30% of the world’s population suffer from joint diseases, and not only people of considerable age are among them. Joint diseases develop rapidly, so it is very important to diagnose them in time and begin to treat. This will help maintain mobility, ease of movement and relieve severe pain.
For your information:
What functions do joints perform?
- Movement in space – it is the joints that allow us to walk, run, jump.
- Mobility – with the help of joints, we cross our legs, squat, raise and lower our hands, clench our fists.
- Preserving the position of the body – the joints allow you to squat or sit on a chair, leaning forward, stand leaning on something.
General examination and palpation method
The first visit to the doctor begins with a general examination, which allows you to see external abnormalities. This may be, for example, swelling in the joint area. At a general examination, the doctor may ask the patient to make certain movements in order to understand the nature of the pain and the area of its spread. Posture and gait can also indicate joint diseases.
Another most common and simplest method of examination is palpation, or palpation. With the help of touches, the doctor discovers the external signs of joint diseases. So, for example, you can find rheumatic and rheumatoid nodules, find the place where discomfort occurs during movements, determine the condition of the joint capsule, change in temperature and humidity of the skin in the joint area.
General examination and palpation are the most affordable methods of examination, but they occur without the use of technical means, so they do not give a complete picture of the clinical picture of the disease.
This is a method of examination using a goniometer – a device that allows you to determine the amplitude of joint mobility. The goniometer resembles a protractor and allows you to determine the angle of mobility. The patient makes a number of necessary movements (flexion, extension, raising and lowering the limbs), and the doctor takes measurements, fixes the indicators and correlates them with the norm.
Laboratory diagnostic methods
More accurate information about the patient’s condition and his disease can be obtained by learning the results of the tests.
Many blood tests indicate joint disease. So, in a biochemical analysis, the doctor will definitely pay attention to the content of C-reactive protein in the blood serum, to the total protein content, to the definylamine reaction and other indicators. An alarm should be considered an increase in ROE (erythrocyte sedimentation reaction), since this reflects the level of the inflammatory process. In rheumatic inflammatory pathologies, an immunological blood test shows antinuclear antibodies (ANA). With arthritis and other joint diseases, the level of uric acid rises sharply in the blood serum. In addition, in patients suffering from rheumatism, psoriatic polyarthritis, ankylosing spondylitis and other joint diseases, there is a change in the content of lysosomal enzymes (acid proteinase, acid phosphatase, deoxyribonuclease, cathepsin) in blood serum and synovial fluid.
Analysis of urine
It is worth noting that significant deviations from the norm in the analysis of urine are observed only in severe forms of joint diseases. However, it should be remembered that in healthy people, protein and blood in the urine should not be present. Their appearance indicates the presence of diseases.
Joint Radiation Diagnostics
In details, the state of the joints and their structure can be studied by methods of radiation diagnostics. Preliminary preparation of these procedures do not require.
Рентгенологическое исследование . Показанием к его проведению могут стать боли в области суставов, затруднительная подвижность, отечность и изменение цвета кожи в области суставов. При обследовании изображение суставов проецируется на особую пленку с помощью рентгеновских лучей. Специальный аппарат направляет лучи на обследуемую область, в целях безопасности все жизненно важные органы человека закрываются защитным свинцовым фартуком. Пациент при этом либо сидит, либо лежит. Рентген позволяет увидеть деформацию суставов и их патологию. Процедура занимает не более трех минут, результаты могут быть представлены минут через 15 в виде снимка. Даже при использовании самой современной аппаратуры минимальное излучение имеет место, поэтому рентген, как и другие лучевые методы исследования, не рекомендуется делать беременным женщинам.
Артрография – более точный метод по сравнению с обычным рентгеном. Его используют при повреждении менисков, связок, подозрении на разрыв суставной капсулы. Перед артрографией суставы искусственно контрастируют. Для этого в полость сустава вводят специальное вещество, затем просят пациента сделать несколько движений и фиксируют изображение прицельной рентгенографией. Результат, в зависимости от аппаратуры, может быть получен на мониторе или на пленке. Процедура длится около 10 минут и не представляет опасности. Однако если у пациента есть аллергическая реакция на йодированные контрастные вещества, это является противопоказанием для данного обследования.
Компьютерная томография (КТ) – самый современный и наиболее информативный метод рентгенологии. КТ позволяет оценить структуру суставных тканей с точностью до миллиметра и сделать «срез» в любой плоскости. Это во многом облегчает лечащему врачу постановку диагноза. КТ может показать изменения в тканях, остеофиты и хрящевые разрастания. В ходе проведения процедуры пациент ложится на кушетку, которая во время обследования начинает двигаться, а специальная трубка передает и улавливает рентгеновские лучи в определенной последовательности. Это длится 2-3 минуты. Степень облучения минимальна. Результат можно получить как в цифровом формате, так и на снимке.
Радионуклеидные методы исследования позволяют распознавать патологии с помощью радиофармпрепаратов. Самый популярный метод радионуклеидной диагностики – сцинтиграфия. В организм вводятся радиоактивные изотопы, а получение качественного изображения достигается за счет испускаемого ими излучения. Процедура происходит с использованием однофотонного эмиссионного компьютерного томографа. Визуализация осуществляется на клеточном уровне и не дублирует результаты других лучевых исследований. Это позволяет видеть функциональные изменения, которые происходят в организме раньше анатомических. Процедура является безопасной, так как используются гамма-изулучающие радионуклеиды с коротким периодом полураспада, лучевая нагрузка не выше, чем при обычном рентгене. Contraindications к проведению обследования: беременность и кормление грудью. Результаты пациент может узнать сразу по ее окончании.
Magnetic resonance imaging of the joints (MRI) is carried out using radio waves and strong magnetic radiation, which make it possible to obtain a clear image of the tissue. The patient lies inside the “tube” of the MRI apparatus. The examination area is indicated by the attending physician. The main requirement for the patient is to lie still, as the quality of the pictures depends on this.
MRI allows you to see in detail the clinical picture of injuries and degenerative diseases of the joints, for example, with chronic arthritis. Also, MRI makes it possible to diagnose osteoarthritis, septic arthritis, osteomyelitis and other diseases. The procedure lasts 10-20 minutes, and the patient can receive a conclusion in the form of an examination protocol and pictures after 20-30 minutes.
This joint examination is not dangerous, since the magnetic field used does not pose a threat to the human body, so there are practically no restrictions here. However, MRI is contraindicated in people who have a pacemaker, hemostatic vascular clips, electronic or ferromagnetic middle ear implants.
Ultrasound examination of joints
This method of joint diagnosis is based on the use of ultrasonic waves. A special apparatus emits waves of a certain frequency, they interact with soft tissues and penetrate the study area. Ultrasound of the joints is prescribed for injuries, rheumatological pathologies, accompanied by inflammatory processes.
Acoustic vibrations are detected by a special scanner, the image immediately appears on the monitor, if necessary, it can be printed, that is, the patient will know the result almost immediately. During the procedure, so that there is no air between the scanner and the examination area, the surface of the body is lubricated with a special gel. The doctor drives the body with a sensor, which does not cause the patient the slightest discomfort. Ultrasound is the safest procedure possible even during pregnancy.
What research method to choose?
The most optimal method for the diagnosis of joints in each case is selected by the attending physician taking into account the patient’s complaints, the state of his body and the need to detail the study area. Sometimes, for the diagnosis of uncomplicated arthrosis of the hip joint at the initial stage, an ordinary x-ray is enough. With complaints of periodic moderate pain, as a rule, this examination is practiced, and it is enough. But, for example, with an advanced form of ankylosing spondylitis, it is better to resort to computed tomography.
Of course, in order to get the most accurate result, it is better to use modern methods for the diagnosis of joints: CT, MRI, ultrasound. You can go to the clinic where such examinations are carried out without prior consultation. The specialist conducting the diagnosis will voice your clinical picture and give an appropriate recommendation, advise which doctor to consult: an osteopath, an orthopedist or a traumatologist.
Tests for arthrosis of the knee
Osteoarthritis of the knee joint is a disease in which deformation and destruction of cartilage occurs, which perform shock-absorbing functions. As a result, there is a loss of joint mobility. It accounts for a quarter of all identified cases. If arthrosis is suspected, regardless of the collected history and visual examination of the patient, tests and special studies are prescribed. The results obtained will help to make an accurate diagnosis and prescribe appropriate treatment.
Patients are referred for examination in the presence of relevant complaints, which are discussed with the attending physician:
- discomfort during walking;
- inconvenience when moving up or down;
- the appearance of pain during exercise;
- the appearance of a crunch in the bones;
- the occurrence of swelling of the joints;
- discoloration of the skin;
- the appearance of severe pain.
A complete blood count is one of the main tests that must be taken to understand the general condition of the body.
All these signs are a good reason to refer a patient for examination for arthrosis.
A general or clinical blood test allows you to evaluate the erythrocyte sedimentation rate (ESR). This helps distinguish arthrosis from arthritis. In the case of arthrosis, no changes occur, with complication of the disease with synovitis, ESR is within 25 mm, with arthritis there is an increase to 40-80 mm, which is provoked by a developing inflammatory process. It is impossible to determine arthrosis solely by ESR.
Indicators of biochemical analysis also do not change. In this case, blood sampling is carried out from a vein. The analysis is given on an empty stomach. Biochemistry allows you to sift out possible diseases that are very similar to arthrosis.
For example, in a biochemical analysis for arthritis, the following changes may occur:
- increased sialic acid levels;
- high concentration of fibrinogen;
- an increase in the amount of C-reactive protein.
One of the most important and most common methods for detecting arthrosis is x-ray of the joints. In the overwhelming majority of cases, this study makes it possible to establish the stage of development of pathology, since changes in the shape of the joint and deformation of the bones are clearly visible in the picture. By radiography, you can also evaluate the width of the gap in the joints. However, this diagnostic method has a significant drawback. It allows you to fix only bones on the picture, but the soft tissues of the joint, including the meniscus and cartilage, do not.
X-rays are able to show unnatural growths of cartilage in the joint.
At the initial stage, the pathology is diagnosed by indirect signs:
- slight narrowing of the joint space;
- subchondral osteosclerosis in the initial stage;
- sharpening the edges of the fossa bone.
In advanced cases of arthrosis in an x-ray, you can see:
- significant narrowing of the interarticular gap;
- progressive subchondral osteosclerosis;
- bone compaction;
- subluxation of the joint;
- free intraarticular bodies;
- reduction in the area of the articular surface;
Important! Only from the picture, the doctor will not be able to assess the degree of damage to the cartilage in the joints with absolute accuracy.
Magnetic resonance therapy
Magnetic waves are used for diagnosis, thanks to them it is possible to consider even small changes in the joints. This diagnostic method is accurate and makes it possible to track changes in cartilage tissue at the earliest stages. Along with this, MRI allows you to evaluate any damage to the ligaments of the knee and menisci.
REFERENCE. Often, during a tomographic examination, specialists, hoping solely on its results, neglect the personal examination of patients.
In addition to the arthrosis identified in the image, the patient may also suffer from other pathologies. In this case, the pain can be triggered not by arthrosis, but arthritis or a damaged meniscus. These pathologies require medical intervention in the first place.
MRI gives a more detailed picture of the structural changes occurring in the joint, but the cost of such a procedure is much higher – on average you will have to pay about 5 rubles per session.
MRI is not prescribed for:
- decompensated heart failure;
- the presence of a pacemaker, defibrillator or insulin pump;
- fixation of bones by Ilizarov apparatus;
- the presence of bullets or fragments in the patient’s body.
Relative contraindications are:
- mental disorders;
- pregnancy and lactation;
- severe condition of the patient
- patient weight more than 120 kg.
One of the most modern and informative methods of examination can be considered computed tomography. It makes it possible to obtain accurate information about the structure of the tissues of the joints and get a cut of the tissues in the picture in any plane. This helps the doctor accurately diagnose.
Important! The computer is inferior in terms of information content to magnetic resonance imaging.
The use of CT for the diagnosis of arthrosis is justified when, for some reason, the patient is unable to undergo an MRI.
Ultrasound is actively used to diagnose joint pathologies. Like MRI, this study allows you to see changes in the soft tissues of the joint:
- cartilage thinning;
- an increase in the amount of joint fluid;
- meniscus damage, etc.
The only negative is that the method is very subjective. Its results directly depend on the specialist who conducted the study and his qualifications.
Ultrasound allows a specialist to diagnose deviations in the knee joint.
Arthroscopy of the knee joint is a modern minimally invasive surgical method for the treatment of pathologies and injuries of the knee joint. The operation is performed without incisions only after 2 punctures with a depth of 1 cm. This allows you to minimize the degree of invasiveness of soft tissues and accelerate the rehabilitation process. Such an intervention is indicated when conservative treatment has not brought positive results.
Arthroscopy of the knee helps minimize the effects of arthrosis:
- During the surgery, damaged tissues are excised, freely moving particles inside the joint are removed.
- The outgrowths – osteophytes are removed.
- The folds of the synovial membrane, irregularities and sharp edges of the articular surfaces are smoothed out.
- Sanitation of the joint cavity is carried out, fragments of destroyed cartilage and fibrous filaments are removed.
In conclusion, a pressure bandage is applied to the knee. The duration of the operation is 30-60 minutes.
Almost immediately after surgery, the patient is allowed to move on crutches without loading the knee joint. To relieve pain, analgesics and compresses are prescribed. From the second day, a course of electromyostimulation is prescribed. What specific procedures will be prescribed depends on the condition of the patient and the individual characteristics of his body.
After a week, the stitches are removed and the patient is discharged from the hospital. After the surgery, physiotherapy, massage, exercise therapy and exercise bikes are recommended.
In the late stages of deforming arthrosis, arthroscopy is considered only as an additional method. She cannot solve the issues of restoring alignment, correcting all contractures. In this case, arthroscopy with corrective arthroplasty is indicated.
Today, there are a lot of methods and tools for detecting arthrosis of the knee joint. It is likely that the attending physician will choose a combination of any diagnostic procedures in order to be absolutely sure of the diagnosis.
What tests are indicated for rheumatoid arthritis?
Given the inflammatory-immune origin of the disease with massive destruction of the articular cartilage, all patients are shown a standardized amount of diagnostic procedures:
- General clinical study. The criterion for diagnosis is leukocytosis with an acceleration of the erythrocyte sedimentation rate (ESR), a shift in the leukocyte formula;
- General an-z urine. It is indicated to exclude concomitant renal damage;
- Biochemical study of blood plasma parameters. Talks about the functioning of the liver and kidneys, the activity of protein loss as a result of the inflammatory process;
- Rheumatic tests. Relate to the gold standard for the diagnosis of RA. They include determining the plasma concentration of acute-phase indicators of inflammation of the articular cartilage. This is primarily rheumatic factor, seromucoid and sialic acids.
- Determination of antibodies of the histocompatibility complex. It is a complex set of immunohistochemical studies that helps in the differential diagnosis between joint damage in lupus erythematosus and RA.
The clinical picture of arthrosis
When making a diagnosis, patients often hear the unfamiliar word arthralgia. In simple terms, arthralgia is the main clinical sign of arthrosis, pain in one or more joints. Arthralgia occurs during exertion, and disappears at rest.
The pain may be sharp, aching, or dull. It depends on several factors:
- pain threshold of the patient;
- localization of arthrosis;
- stage of the disease.
The pain is localized, both directly in the joint area and around it. Also a characteristic feature of arthrosis is increased pain in the evening. Night pains are characteristic of late stages of arthrosis. At the same time, patients experience such painful sensations that they suffer from insomnia. By morning, unpleasant feelings wane and the patient falls asleep.
Swelling of tissues may be mild. This symptom occurs in the late stages of arthrosis. Often the pain is localized in several joints. This indicates the presence of polyarthrosis in a person, that is, dystrophic changes in several areas.
A frequent sign of illness is stiffness of movements. In this case, the patient feels discomfort during movements. In the morning, immediately after sleep, discomfort is present when the joint is bent, and it takes some time and a warm-up to get rid of the feeling of stiffness.
What you should pay attention to
A special indicator of the activity of inflammation is ESR. Its normal values are different for men and women. In the second case, they should be slightly higher than normal. With inflammation, there is a sharp increase in the numbers of this indicator, which is always more than 20 mm / hour. In the active phase of the disease can reach 50-70 mm / hour. A feature of ESR in rheumatoid arthritis is its long-term preservation at a high level.
Another very revealing blood test for rheumatoid arthritis is the definition of rheumatoid test. They not only indicate the degree of inflammation activity, but also help to assess the body’s response to the prescribed anti-inflammatory drugs. After all, the basis of their formation is a destructive process with the release of a large number of pathological protein structures.
A general clinical blood test is one of the most uninformative methods for laboratory diagnosis of rheumatoid arthritis. It is always carried out to determine other indicators of the hematopoietic system, which carry general information about the functioning of the body as a whole.
Briefly about the diagnosis
Diagnosis of arthrosis is based on a set of studies, including laboratory, clinical and radiological methods. Each type of study is important, as it helps determine the form and specificity of the disease. Lack of information about the existing disease can negatively affect the selected treatment and the patient’s recovery.
So, clinical studies involve a history of the patient, an external examination of the patient, as well as palpation of the diseased joint. The doctor additionally notes the presence of a crunch and painful nodules in the affected area of the tissue.
An x-ray is used to confirm the clinical picture and helps to determine the degree of neglect of the disease, the activity and nature of the inflammatory process. Additionally, tomography, radiography of a functional type are prescribed.
Laboratory studies are important in determining the nature of the disease. One of the main tests that are used for this purpose is blood biochemistry. This type of research is necessary in order to determine the degree of damage to the joint, the intensity of inflammation and correctly diagnose it.
Symptoms that confirm the development of RA
Unfortunately, there are no symptoms of this disease, the appearance of which could accurately make this diagnosis.
But, nevertheless, some of the symptoms of this disease are specific enough so that the doctor can suspect rheumatoid arthritis and prescribe laboratory tests to confirm or deny the presence of this disease.
- the disease usually begins with small joints of the legs and (more often) the hands;
- in the vast majority of cases, symmetrical joints are affected – i.e. on both arms or legs;
- characterized by “morning stiffness” of the joints, which decreases over time – within an hour or several hours.
In addition, the emerging symptoms of the disease can tell a doctor a lot about how this disease will proceed. So, if already at the initial stage of the disease many joints are affected, rheumatic nodules appear early, and also if large joints are affected at the very beginning of the disease, this may indicate that the course of rheumatoid arthritis will be severe – and therefore, it is necessary to begin treatment As soon as possible.
What can biochemical analysis say?
Blood biochemistry is an important analysis necessary to study the quantitative and qualitative characteristics of the chemical composition of blood. Research is needed to differentiate the disease and distinguish arthritis from arthrosis.
The fact is that, according to clinical signs, arthritis and arthrosis are similar. Often, doctors at the initial stages of diagnostic studies confuse pathologies due to the similarity of symptoms. Only after receiving tests on the hands, the doctor can talk about the treatment of the disease and the appointment of therapy.
Signs of RA on an X-ray
Alas, the diagnosis of this difficult disease with the help of an X-ray examination in the early stages of the disease does little. If the disease started relatively recently, an x-ray can only show the appearance of excess fluid in the affected joints and the presence of soft tissue edema near them: but such information can also be obtained with the naked eye when examining the patient.
And only when the disease is already actively developing, several months after its onset, during an exacerbation on X-rays, you can see signs specific for rheumatoid arthritis: characteristic erosions appear in the affected joints of the hands, which are also called “usuras”.
In addition, with the active course of the disease process, the joint spaces in diseased joints are significantly reduced – to the extent that the bones that enter these joints grow together, forming fixed joints – ankyloses.
Naturally, bringing the disease to such a state is not recommended, and it was necessary to consult a doctor much earlier.
Changes in blood counts with arthrosis
There is a difference between arthritis and arthrosis. These diseases are different in nature of origin. So, arthritis is an inflammatory disease. Inflammation leads to pathological processes in the joint tissues. In the case of arthrosis, destructive processes occur as a result of metabolic disturbances in the human body and tissues, in other words, a lack of any substances and trace elements.
It is the analysis of these indicators that helps the doctor distinguish one disease from another and make a diagnosis of arthrosis.
Synovial fluid examination
In some cases, it makes sense for the doctor to conduct a study of synovial fluid located in the joint affected by the disease. But even this information does not provide sufficient grounds for the diagnosis of rheumatoid arthritis. The synovial fluid will be cloudy, its viscosity will be reduced, and the amount of protein in its composition will be increased.
However, this information only indicates the presence of inflammation in the joint, which can be caused by a variety of reasons – from synovitis in osteoarthritis of the joints to reactive arthritis caused by intestinal or urogenital infection.
Therefore, this study will not give the doctor a 100% guarantee in making the correct diagnosis. However, the following studies usually provide more useful information.
1. It is important to control weight. Extra pounds give a load on the articular and cartilage tissues. Scientists have proven that most patients with arthrosis are obese.
2. Organization of moderate exercise. The presence of large loads does not guarantee joint health, and even harms. Low mobility also does not guarantee the safety of joints and safety against arthrosis. Correct load distribution and moderate activity (running, swimming, skiing) improves microcirculation in the joints and surrounding tissues.
3. The joints are kept warm. Cold affects joints adversely. It is important to avoid hypothermia.
4. Injury to joints is not allowed. If this happens, it is better to seek medical help at the clinic where treatment will be prescribed. Injury often leads to post-traumatic arthrosis.
5. Proper shoes will protect a person from arthrosis. Prefer comfortable boots at low speed. Dangerous shoes on the platform or heel. Wearing shoes with such a sole threatens to dislocate, injure and strain the joints of the legs.
By following these simple guidelines, a person can stay healthy for years to come.
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