Investigations

• ESR usually raised according to active disease

• anaemia (normochronic and normocytic) may be present

• rheumatoid factor—positive in about 80-85%

• antinuclear antibodies—positive in 30%

o erosion of joint margin: 'mouse-bitten' appearance o loss of joint space (may be destruction) o juxta-articular osteoporosis o cysts o advanced: subluxation or ankylosing Criteria for the diagnosis of rheumatoid arthritis are presented in Table 31.5 .

Table 31.5 American Rheumatism Association: criteria for the diagnosis of rheumatoid arthritis

• For classical RA 7 criteria needed

• For definite RA 5 criteria needed

• For probable RA 3 criteria needed

1. Morning stiffness

2. Pain on motion or tenderness in at least one joint

3. Swelling of one joint, representing soft tissue or fluid

4 Swelling of at least one other joint (soft tissue or fluid) with an interval free of symptoms no longer

4. than three (3) months

5. Symmetrical joint swelling (simultaneous involvement of the same joint, right and left)

6. Subcutaneous nodules over bony prominences, extensor surfaces or near joints

7 Typical X-ray changes that must include demineralisation in periarticular bone as an index of

7. inflammation

8. Positive test for rheumatoid factor in the serum

9. Synovial fluid—a poor mucin clot formation on adding synovial fluid to dilute acetic acid

Synovial histopathology consistent with RA: (a) marked villous hypertrophy

10. (b) proliferation of synovial cells

(c) lymphocyte plus plasma cell infiltration in subsynovium

(d) fibrin deposition within or upon microvilli

11. Characteristic histopathology of rheumatoid nodules biopsied from any site

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