Rheumatoid Arthritis

类风湿性关节炎诊断

Early diagnosis of rheumatoid arthritis is ideal.

Joseph Bennington-Castro
经过 医学审查
Reviewed:
医学看过
Imaging tests like X-rays are part of the diagnosis process. Unfortunately, there is no single test that can definitively diagnose RA. To get an accurate diagnosis, doctors take many steps.
X射线有助于诊断RA;许多因素进入诊断过程。 iStock
If rheumatoid arthritis (RA) is left untreated, inflammation from the condition can start to develop in other areas of the body, causing various and sometimes serious complications that can affect other organs — such as the heart, lungs, eyes, and nerves — and could cause significant long-term disability.

如果你正在经历类风湿性关节炎症状，重要的是尽快诊断，以便您可以获得及时治疗。对于许多人来说，功能性残疾 - 每天惯例的麻烦，如敷料，进食和行走，由关节损伤引起的 - 经常发生在实际诊断前一到两年。这些问题可能是您有ra的信号。

有关的：早期类风湿性关节炎治疗：为什么这么重要？

类风湿性关节炎初步诊断

没有单一的测试可以肯定诊断RA.。

与其他疾病一样，RA的诊断通常始于您的医生获得医学史并进行体检。

You doctor will begin by asking questions about the symptoms you're experiencing, including when and how they occur and how they've changed over time (if they have). One specific symptom they will ask about is morning joint stiffness that lasts for at least 30 minutes and occurs in the peripheral joints rather than the lower back — a commonra症状。

早晨僵硬is typically severe enough to interfere with physical functions after waking up.

其他主要症状是持续六周的关节肿胀，特别是如果肿胀发生在身体两侧的相同接头上。发生不到六周的肿胀可能是多个不同的东西的标志;一个例子是急性病毒多性多动力炎，一种由病毒引起的关节的炎症。

你的医生也会询问其他医疗conditions you have —ra的人frequently have co-occurring conditions, such as心血管疾病- 以及你的直系亲属的人。

You have more than double the risk of developing RA than the general population if you have a first-degree relative (parent, offspring, sibling) with RA, according to a study published in November 2019 in the journalArthritis Care & Research。

如果您有炎性肠病的家族史，您的风险也大大增加，lupus，硬皮病或甲状腺疾病。

在您的体检期间，您的医生将寻找关节的温柔，肿胀，温暖和疼痛的迹象，并检查您是否有任何运动限制。RA的关节肿胀通常是“柔软的”，与骨关节炎的“硬”（骨）肿胀相比。

他们还将检查类风湿性结节那or noticeable bumps that often occur at the base of arthritic joints, such as the elbows.

根据期刊发布的研究，这些结节最多影响患者的30％Autoimmunity Reviews。

遵循这些初步诊断程序，您的医生将订购血液测试。

类风湿因子和其他抗体的试验用于诊断类风湿性关节炎

Rheumatoid arthritis is typically defined as being either "seropositive" or "seronegative," referring to the presence of specific antibodies in the blood.Rheumaticnodules occur almost exclusively in people with seropositive RA.

Previously, patients were considered seropositive if they had the antibodyrheumatoid factor那or RF. But these antibodies are found in only 80 percent of people with RA.

更重要的是，RF也发现了许多其他条件的人 - 包括一些感染（单核细胞多疾那结核），其他煽动性或自身免疫条件（lupus那Sjögren's syndrome, scleroderma), and certain cancers (白血病那多发性骨髓瘤） - 因此它的存在不一定表示RA。

今天,一个米ore sensitive test for seropositivity is available. This test looks for anti-citrullinated protein antibodies (ACPAs), a collection of autoantibodies — antibodies that target and react to a person's own proteins, mistaking them as foreign. To detect ACPAs, the test looks for evidence of the antibodies' immune system reactivity with compounds called cyclic citrullinated peptides (CCPs), which are fragments of natural human proteins undergoing a certain type of molecular change.

About 60 to 70 percent of people with RA have these so-called anti-CCPs, and these antibodies can show up years before symptoms develop, according to the Arthritis Foundation.

Compared with RF, anti-CCP is a more specific marker of the disease, and high levels of anti-CCP antibodies may indicate a greater RA severity.

In recent years, researchers have identified a number of different ACPAs, detected through the anti-CCP tests. A study published in June 2018 in the journal血清疾病的血清发现没有单一的ACPA负责RA关节损伤和炎症。

而是，根据研究，具有许多不同的ACPA与许多关节破坏和炎症的标记相关。这表明反CCP测试可能能够帮助临床医生确定谁将产生更大的联合损害。

Though RF and anti-CCP antibody tests are highly informative and can help with diagnoses, they're not enough to diagnose RA alone.

据医院为特殊外科医院，最多一半的患者在初步测试时，患者的一半患者没有射频和抗CCP抗体，而20％的人从未对抗体进行阳性测试。

Other Tests for Seropositive Rheumatoid Arthritis

Blood testsare not only used to detect RF and anti-CCP antibodies. They're also used to reveal if you have:

  • Anemia那or low red blood cell count, which occurs in up to一半的人用ra
  • A high erythrocyte sedimentation rate, also known as a sed or ESR rate, a crude measure ofinflammation in your body
  • High C-reactive protein (CRP) levels, another marker of inflammation
Like the antibody tests, these tests alone cannot diagnose RA. The ESR rate, for instance, is not specific to RA inflammation and can also be influenced by infections and age. And CRP, which is also not specific to RA, can be influenced by obesity and infection.

但是，当与其他线索结合时，高ESR或CRP可以帮助进行RA诊断。

除了血液测试，一个X-ray可以帮助您的医生确定关节中的破坏程度，但可能只有很有用RA.has progressedto a later phase.

In recent years,ultrasoundand磁共振图像（MRI）通过帮助检测联合炎症，侵蚀和流体堆积，扫描具有改善的RA诊断。但是，理想情况下，医生想要诊断并开始treating RA在结构损伤之前显示成像测试。

血清湿性关节炎如何诊断出？

Some patients still have RA but do not test positive for either anti-CCPs or RF — they have血清基RA.。

这种形式的RA通常更难以诊断，并且通常也产生比血清阳性RA更温和的症状。遗传链接，环境风险和血清率ra的药物的反应性也与血清阳性RA不同。在2020年3月发表的一项研究血清疾病的血清表明，苏因因子RA变得越来越普遍，2005年至2014年在1985年至1994年间的10,000人中有10,000人之间跳跃到20人中有10,000人。

要诊断SERONEGATIVE RA，您的医生可能会进行更多的测试，以排除症状的其他可能原因，例如骨关节炎- 有时被误诊。虽然骨关节炎可能会对Ra产生类似的症状，但骨关节炎是一个退行性关节疾病从“磨损”而不是与自身免疫问题相关的炎症发展。

您的医生可以测试您的血液以进行感染，包括人类parvovirus b19，乙型肝炎那丙型肝炎， 和莱姆病。这些issues can produce RA-like symptoms. They may also analyze the fluid within your joints to detect abnormalities and high white blood cell counts.

您的医生也可能进行滑膜biopsy，这涉及去除一小块衬里的组织衬里。

但即使在这些测试中，也没有保证对血清基度的正确诊断。例如，关节液测试的结果可以表示您具有慢性的痛风。你的医生可以诊断你psoriatic arthritis如果你以后开发一个皮疹。

Other diseases that may resemble seronegative RA include reactive arthritis and强直性脊柱炎那a form of chronic inflammatory arthritis that primarily affects the spine.

有关的：Psoriatic vs Rheumatoid Arthritis: What’s The Difference?

临床前类风湿性关节炎

Some people are highly at risk of RA but don't yet have the condition — instead, they may have临床前RA.。

People with preclinical RA have the biomarkers (RA or anti-CCP) of RA but don't have the hallmark joint inflammation associated with the disease. Research suggests that tests can detect these biomarkers and autoantibodies three to five years before RA joint systems arise.

但这并不是说临床前RA的人没有健康问题。它们可能有轻度疼痛和疼痛，在身体的一侧关节肿胀，或者一些不良标志疲劳或不适，以及更高的心脏病发作的风险那心脏衰竭那depression和情绪障碍。一项研究发现，临床前RA的人们在10年期间有24％的风险患有心血管事件的风险。

对于那些有临床前RA的人，疾病改性的抗逆素药物用于治疗Ra.那can significantly reduce RA risk, according to a meta-analysis published in August 2018 in the血清疾病的血清。

用红外光诊断类风湿性关节炎

In the near future, physicians may be able todiagnose RA with a noninvasive procedure using infrared light。

在2019年6月20日发布的试点研究中，在Journal of Biomedical Optics，研究人员发现，该技术涉及将人的手放在红外扫描仪中，可以准确地检测RA炎症的标志物。

但专家认为，该技术还没有准备好临床使用，因为它不能对RA的明确诊断，不能区分不同类型的RA。

社论来源和事实检查

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