Rheumatoid arthritis checkup: three major items that cannot be forgotten

It is understood that the cause of rheumatoid arthritis is mostly related to genetics, infection or sex hormone secretion. It is a disease with a relatively high incidence in clinical practice. Patients often experience severe pain that is unbearable. So, when going to the hospital for a checkup, what items should be checked for rheumatoid arthritis?

1. Laboratory inspection

(1) General examinations include blood and urine routine, erythrocyte sedimentation rate, C-reactive protein, biochemistry (liver and kidney function, A/G), immunoglobulin, protein electrophoresis, complement, etc.

(2) Autoantibodies: rheumatoid factor (RF-IgM), anti-cyclic citrullinated (CCP) antibodies, rheumatoid factor IgG and IgA, anti-perinuclear factor, anti-keratin antibodies, as well as anti-nuclear antibodies, anti-ENA antibodies, etc.

(3) Genetic markers HLA-DR4 and HLA-DR1 subtypes.

2. Imaging examination

(1) X-ray films of joints can show soft tissue swelling, osteoporosis, and cystic changes in the joint surface, invasive bone destruction, blurred joint surface, narrow joint space, joint fusion and dislocation after the disease progresses. X-ray staging: ① Stage I normal or osteoporotic; ② Stage II osteoporosis, mild bone invasion or destruction under the joint surface, mild narrowing of the joint space; ③ Stage III obvious bone invasion and destruction under the joint surface, obvious narrowing of the joint space, and joint semi-dislocation deformity; ④ Stage IV the above changes are combined with fibrous or bony ankylosis of the joint. Chest X-ray films can show interstitial lung disease, pleural effusion, etc.

(2) CT examination: Chest CT can further indicate lung lesions, especially high-resolution CT, which is more sensitive to interstitial lung lesions.

(3) MRI examination of the hand and wrist joints can indicate early synovitis lesions and is very helpful in detecting early joint damage in patients with rheumatoid arthritis.

(4) Ultrasound Joint ultrasound is a simple, non-invasive examination that is valuable for distinguishing synovitis, joint effusion, and joint destruction. Studies have shown that it has good consistency with MRI.

3. Special inspection

(1) Joint puncture: For joints with joint effusion, joint fluid examination includes: joint fluid culture, rheumatoid factor detection, anti-CCP antibody detection, anti-nuclear antibody, etc., and polarized light detection to identify urate crystals of gout.

(2) Arthroscopy and synovial biopsy are very valuable for the diagnosis and differential diagnosis of RA, and have an auxiliary therapeutic effect for monoarticular refractory RA.