J Korean Med Assoc.  2010 Oct;53(10):862-870. 10.5124/jkma.2010.53.10.862.

Clinical manifestations and diagnosis of rheumatoid arthritis

• Ha YJ
• Lee SK

• KMID: 2188411
• DOI: http://doi.org/10.5124/jkma.2010.53.10.862

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disorder that mainly affects the diarthrodial joint. Morning stiffness and symmetric swelling of the wrists, PIPs and MCPs constitue the typical history for rheumatoid arthritis. Extra-articular manifestations in RA include constitutional symptoms, distinct organ manifestations and severe multiorgan disease. The presence of rheumatoid factor and the anti-cyclic citrullinated peptide antibody, which is more specific to RA, are helpful in RA diagnosis. Although conventional radiographs remain the initial imaging modality in patients with RA, other imaging modalities such as MRI or ultrasound have demonstrated increased sensitivity to detecting early erosive change. To the present day, there is no single test that confirms RA. Early diagnosis of RA is essential because there is substantial evidence that early therapeutic intervention with non-biologic/biologic disease-modifying antirheumatic drugs leads to a better outcome. Although the 1987 American College of Rheumatology (ACR) classification criteria for RA have been used as the gold standard in clinical studies, these criteria are misleading early in the disease course. The ACR/European League Against Rheumatism (EULAR) is scheduled to release the new classification criteria for RA soon. This review describes clinical manifestations of RA, diagnostic tools, as well as the classification criteria in the diagnosis of RA.

Keyword

Signs and symptoms; Diagnosis; Rheumatoid arthritis

MeSH Terms

Antirheumatic Agents
Arthritis, Rheumatoid
Early Diagnosis
Humans
Joints
Rheumatic Diseases
Rheumatoid Factor
Rheumatology
Wrist
Antirheumatic Agents
Rheumatoid Factor

Reference

1. Lipsky PE. Chapter 314, Rheumatoid arthritis. Harrison's Principles of Internal Medicine. c2008. 17th ed. New York (USA): Mc Graw Hill;2083–2092.

2. Pedersen M, Jacobsen S, Klarlund M, Frisch M. Socioeconomic status and risk of rheumatoid arthritis: a Danish case-control study. J Rheumatol. 2006. 33:1069–1074.

3. Visser H. Early diagnosis of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2005. 19:55–72.

4. Smolen JS, Landewé R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, Gorter S, Knevel R, Nam J, Schoels M, Aletaha D, Buch M, Gossec L, Huizinga T, Bijlsma JW, Burmester G, Combe B, Cutolo M, Gabay C, Gomez-Reino J, Kouloumas M, Kvien TK, Martin-Mola E, McInnes I, Pavelka K, van Riel P, Scholte M, Scott DL, Sokka T, Valesini G, van Vollenhoven R, Winthrop KL, Wong J, Zink A, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010. 69:964–975.

5. Lineker S, Badley E, Charles C, Hart L, Streiner D. Defining morning stiffness in rheumatoid arthritis. J Rheumatol. 1999. 26:1052–1057.

6. Lee SK. Causes and symptoms of rheumatoid arthritis. J Korean Med Assoc. 1992. 35:1213–1222.

7. Turesson C, O'Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003. 62:722–727.

8. Young A, Koduri G. Extra-articular manifestations and complications of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007. 21:907–927.

9. Jeong SH. Interstitial Lung Diseases in Collagen Vascular Diseases. J Korean Med Assoc. 2009. 52:30–40.

10. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988. 31:315–324.

11. Sokka T, Pincus T. Joint counts to assess rheumatoid arthritis for clinical research and usual clinical care: advantages and limitations. Rheum Dis Clin North Am. 2009. 35:713–722.

12. Otterness IG. The value of C-reactive protein measurement in rheumatoid arthritis. Semin Arthritis Rheum. 1994. 24:91–104.

13. Park SH. New diagnostic method of rheumatoid arthritis. Korean J Med. 2009. 76:7–11.

14. Schellekens GA, Visser H, de Jong BA, van den Hoogen FH, Hazes JM, Breedveld FC, van Venrooij WJ. The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide. Arthritis Rheum. 2000. 43:155–163.

15. Tedesco A, D'Agostino D, Soriente I, Amato P, Piccoli R, Sabatini P. A new strategy for the early diagnosis of rheumatoid arthritis: a combined approach. Autoimmun Rev. 2009. 8:233–237.

16. Devauchelle Pensec V, Saraux A, Berthelot JM, Alapetite S, Jousse S, Chales G, Thorel JB, Hoang S, Nouy-Trolle I, Martin A, Chiocchia G, Youinou P, Le Goff P. Ability of foot radiographs to predict rheumatoid arthritis in patients with early arthritis. J Rheumatol. 2004. 31:66–70.

17. Devauchelle-Pensec V, Berthelot JM, Jousse S, Samjee I, Josseaume T, Colin D, Chalés G, Thorel JB, Hoang S, Martin A, Youinou P, Le Goff P, Saraux A. Performance of hand radiographs in predicting the diagnosis in patients with early arthritis. J Rheumatol. 2006. 33:1511–1515.

18. Boutry N, Morel M, Flipo RM, Demondion X, Cotten A. Early rheumatoid arthritis: a review of MRI and sonographic findings. AJR Am J Roentgenol. 2007. 189:1502–1509.

19. Ostergaard M, Pedersen SJ, Dohn UM. Imaging in rheumatoid arthritis-status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol. 2008. 22:1019–1044.

20. Majithia V, Geraci SA. Rheumatoid arthritis: diagnosis and management. Am J Med. 2007. 120:936–939.

21. Aho K, Palusuo T, Kurki P. Marker antibodies of rheumatoid arthritis: diagnostic and pathogenetic implications. Semin Arthritis Rheum. 1994. 23:379–387.

22. Banal F, Dougados M, Combescure C, Gossec L. Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis according to disease duration: a systematic literature review and meta-analysis. Ann Rheum Dis. 2009. 68:1184–1191.