Diagnostic criteria for rheumatoid arthritis
2016/07/04 16:33:31
For any disease, early diagnosis and timely treatment should be made in order to get twice the result with half the effort. Most patients with advanced rheumatoid arthritis have multiple joint lesions and typical deformities, so there is no difficulty in diagnosis. But in the early stage of the disease, it is often difficult to diagnose only a few joints. In particular, rheumatoid arthritis can not be diagnosed only by history and clinical manifestations. So, how do we correctly diagnose rheumatoid diseases? After consulting experts extensively, the American Rheumatology Society proposed a revised diagnostic standard in 1958, which is currently used in many countries. In addition, the diagnostic criteria for this disease were also proposed in China. The following are the following:
(1) diagnostic criteria for rheumatoid arthritis in the American Society of Rheumatology
1. morning stiff.
2. at least one joint is painful or tenderness during activity (as seen by doctors).
3. at least one joint is swollen (soft tissue hypertrophy or effusion rather than hyperosteogeny, seen by doctors).
4. At least another joint is swollen (as seen by the doctor, the interval between the two joints should not exceed 3 months).
5. Symmetrical joint swelling (as seen by the doctor) and invasion of the same joint on both sides of the body (if the invasion of the proximal interphalangeal joints, metacarpophalangeal joints or the FDA3_toe joints do not require complete symmetry). The involvement of distal interphalangeal joints can not meet this criterion.
6. subcutaneous nodules extending on the side of the bony protuberance or joints.
7. standard X ray films (except for bone hyperplasia) must have osteoporosis near the affected joints.
8. rheumatoid factor positive.
9. mucin in synovial fluid is poorly solidified.
10. There are three or more of the following synovial pathological changes: prominent villous hyperplasia; hyperplasia and palisade of synovial cells in the surface layer; marked infiltration and lymph node formation of chronic inflammatory cells (mainly lymphocytes and plasma cells); dense cellulose deposition in the surface or stroma; and focal necrosis.
11. Histological changes in the subcutaneous nodules should show necrotic foci of cells in the central area surrounded by palisade macrophages and the outermost infiltration of chronic inflammatory cells.
Typical rheumatoid arthritis: its diagnostic criteria require 7 of the above items. In the 1~5 item, joint symptoms must last at least 6 weeks.
Affirming rheumatoid arthritis: its diagnosis requires 5 of the above items. In the 1~5 item, joint symptoms must last at least 6 weeks.
Rheumatoid arthritis may be diagnosed: 3 of the above items are required for diagnosis, and at least 1 of 1~5 items. The joint symptoms must last at least 6 weeks.
Suspicious rheumatoid arthritis: the diagnosis of rheumatoid arthritis requires two of the following items, and the duration of joint symptoms should be no less than three weeks:
The morning is stiff.
2. Tenderness and activity pain (seen by doctors), intermittent or sustained for at least 3 weeks.
(3) history or findings of joint swelling.
Subcutaneous nodules (seen by doctors).
Erythrocyte sedimentation rate increased and C reactive protein was positive.
Iriratitis (unless it is suspected of rheumatoid arthritis in children).
(2) domestic diagnostic criteria (Revised and approved by the 1988 National Conference on Integrated Traditional Chinese and Western medicine for rheumatic diseases)
(1) Symptoms: mainly small joints, mostly multiple joint swelling and pain or symmetrical small joint swelling and pain (a single person must be seriously distinguished from others, joint symptoms lasting at least 6 weeks), morning stiffness.
(2) Physical signs: swelling and tenderness of the involved joints, limited mobility, or deformity, or ankylosis, some cases may have subcutaneous nodules.
Laboratory examination: RF (rheumatoid factor) was positive, ESR (erythrocyte sedimentation rate) increased more rapidly.
X-ray examination: the key joints involved have typical X-ray manifestations of rheumatoid arthritis.
All patients with the above symptoms and signs, or both RF positive, or both typical X-ray manifestations can be diagnosed. And the following stages.
(1) Early stage: Most of the involved joints had swelling and pain and limited movement, but X-ray showed only soft tissue swelling and osteoporosis.
(2) In the middle stage, the function of some involved joints was obviously limited, and X-ray showed that the joint space became narrow and the bone erosion was different.
(3) Late stage: most of the involved joints appear various deformities or rigidity, difficult to move, X-ray shows serious joint damage, dislocation or fusion.