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Diagnosis

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In general, a primary care physician can diagnose osteoarthritis by reviewing the patient's medical history and performing a physical examination. The diagnosis is often confirmed using x-rays and laboratory tests (e.g., joint aspiration).

A medical history involves questions concerning any past surgeries and medical procedures, current health conditions, and family history of arthritis. Questions that the physician may ask include the following:

• Does the pain feel sharp, grinding, or burning?
  
• Does the pain increase or decrease throughout the day?
  
• Is the pain associated with any particular activity?
  

During a physical exam, the physician determines if joint swelling and tenderness are present, evaluates the range of motion, and looks for bony growths in or around the joint(s).

Joint aspiration is another test that may be used to diagnosis OA. In this procedure, the synovial fluid (fluid within the joints) is examined for signs of damage. A local anesthetic is used and a needle is inserted into the joint to withdraw fluid.

Primary care physicians may offer a preliminary diagnosis of rheumatoid arthritis, but if the condition is suspected, the patient is referred to a rheumatologist for a complete diagnosis and for treatment. The diagnosis of RA may also involve taking a complete medical history, and performing a physical examination, laboratory tests, and x-rays. Questions that the physician may ask include the following:

• Does the joint pain occur symmetrically (on both sides of the body)?
  
• Have there been periods of weakness, fatigue, and discomfort?
  
• At what time of day is the pain most severe?
  

During a physical exam, in addition to looking at the joints, the doctor may also examine the skin, lungs, and eyes for signs of RA.

Laboratory tests used to diagnose RA vary, as there is no test or combination of tests used specifically to diagnose the condition. One test that may be performed is a complete blood cell count (CBC). Patients with rheumatoid arthritis may have lower counts of red blood cells (causing anemia), higher counts of white blood cells (indicating an immune response), and higher platelet counts (a sign that inflammation is present).

An erythrocyte sedimentation rate (ESR or sed rate) is another common test used to diagnose RA. This test measures how fast red blood cells fall to the bottom of a test tube, indicating how much inflammation may be present in the body. Following diagnosis, this test may also be done periodically to monitor the progression of the condition and the success of treatment.

Additional diagnostic tests that may be used include rheumatoid factor (RF), C-reactive protein (CRP), and antinuclear antibodies (ANA) tests. X-rays may be first used to evaluate current joint conditions, and then to determine the progress of the disease and the effectiveness of treatment. Magnetic resonance imaging (MRI scan) may also be performed to detect early inflammation that is not shown on x-ray.

Arthritis, Diagnosis reprinted with permission from rheumatologychannel.com
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