Rheumatoid Arthritis Nodules

Rheumatoid arthritis (RA) is a progressive, systemic autoimmune disease that causes inflammation of the joints. Initially, the small joints such as hands, wrists and feet tend to be more involved large joints. Because RA is a systemic disease can cause significant damage to internal organs such areas as the lungs, skin, blood-producing organs, heart and eyes.

More than 2 million Americans are affected by RA.

It is essential to the diagnosis of rheumatoid arthritis as soon as possible to avoid damaging the joints and internal organs.

The traditional criteria for the diagnosis of rheumatoid arthritis are the American College of Rheumatology criteria:

1.Morning stiffness in and around joints, lasting at least I hour before maximum improvement.

2.Arthritis areas of 3 or more common along with soft tissue swelling seen by a doctor. Possible areas include the fingers, knuckles, wrsits, elbows, ankles, knees and feet.

3.Arthritis affecting the joints of the hands of at least one area swollen in a wrist joint or finger.

Arthritis 4.Symmetric with the simultaneous participation of the same joint on both sides of the body (bilateral involvement of the fingers, toes, feet or is acceptable without absolute symmetry.

5.Rheumatoid nodules: Subcutaneous nodules over bony prominences or extensor surfaces, or close to joints observed by a physician.

6.Serum rheumatoid factor: abnormal amounts of serum rheumatoid factor by any other method whose result was positive in less than 5 percent of the control subjects.

7.Radiographic (X-ray) changes: typical of rheumatoid arthritis on radiographs of hands, wrists. Must include erosions or demineralization in or near the affected joints.

For classification purposes, a patient must meet at least four of seven criteria. Criteria 1-4 must have been present for at least six weeks. Patients with two clinical diagnoses are not excluded. Although these criteria are fine for standardization purposes in doing research for consistency, they are not necessarily intended to be strictly followed in a clinical setting.

More recently, the use of tests such as anti-cyclic citrullinated peptide (anti-CCP) assay has provided a more specific method to identify patients whose symptoms of arthritis will lead to RA.

In a recent study, Japanese researchers have found that the combination "a positive rheumatoid factor, elevated C-reactive protein, swollen joints, and an anti-CCP was very specific and precise, it is easy to use for physicians and therefore beneficial to patients "(T Yamane, et al. Journal of Rheumatology, January 2008).

As a practicing rheumatologist, I find this article useful in that it confirms what many of us here in the United States have also found to be true. The diagnosis of RA, by all means, is not necessarily easy.

However, making the diagnosis is essential to initiate aggressive treatment. What is very important to remember is that, today, the diagnosis of rheumatoid arthritis is not necessarily a bad thing for a patient. The new biologic drugs are made "to a patient in remission" more likely than a scenario.

Data from the Japanese study supports a simple and direct method to diagnose quickly.