Patients with advanced rheumatoid arthritis, because of the occurrence of multi joint lesions and typical deformities, so there is no diffic
Patients with advanced rheumatoid arthritis, because of the occurrence of multi joint lesions and typical deformities, so there is no difficulty in diagnosis. However, the early disease and a few cases of joint involvement, often difficult to diagnose. At present, there are different standards for the diagnosis of rheumatoid arthritis. In 1958 American College of Rheumatology is proposed through changes in the diagnostic criteria, many countries have adopted this standard. Are described as follows:
(1) the morning.
(2) at least one joint pain or tenderness.
(3) at least one joint is swollen (soft tissue hypertrophy or effusion rather than bone hyperplasia, seen by doctors).
(4) at least the other joint is swollen (as seen by the physician, the interval between the two joints should be no more than 3 months).
(5) symmetric swelling joints (see the doctor), and violation of the same joint on both sides of the body (if the violation of the proximal interphalangeal joints, metacarpophalangeal joints and toe joints need not completely symmetrical), distal interphalangeal joint involvement does not meet the standard.
(6) a subcutaneous nodule on the extensor side of the bone or near the joint (seen by the physician).
(7) as seen in the standard radiographs (except for bone hyperplasia, there must be osteoporosis in the vicinity of the affected joints).
(8) rheumatoid factor positive.
(9) poor coagulation of synovial fluid.
(10) has the pathomorphology of three or more changes: obvious villous surface; synovial cell hyperplasia and palisading; obvious chronic inflammatory cells (mainly lymphocytes and plasma cells infiltration and lymph nodes) formation tendency; surface or interstitial dense fibrin deposition; focal necrosis.
(11) the histological changes in the subcutaneous nodules should show the central area of the cell necrosis, surrounded by the proliferation of palisade macrophages and the outermost layer of chronic inflammatory cells infiltration.
Typical rheumatoid arthritis: the diagnostic criteria for 7 of the above items. In (1) - (5), the joint symptoms must last for at least 6 weeks. Rheumatoid arthritis: its diagnosis requires 5 of the above items. In (1) - (5), the joint symptoms must last for at least 6 weeks.
May be rheumatoid arthritis: the diagnosis of 3 of the above items, (1) - (5) in at least 1 items. At least 6 weeks.
Suspected rheumatoid arthritis: the diagnosis requires 2 of the following items, and the duration of the joint symptoms should be no less than 3 weeks:
Tenderness and pain during activity (seen by the doctor), intermittent or sustained for at least 3 weeks.
History of swelling of joints.
The subcutaneous nodules (see doctor).
The ESR, C- reactive protein.
The iritis (except in rheumatoid arthritis in children, or of dubious value).