Identifying arthritis, or inflammation and swelling of the joints, can be a complex process. Doctors use several different tests to correctly identify the type of arthritis and prescribe an accurate treatment program. Doctors include a comprehensive physical examination and history of the patient and the patient's family as well as certain blood tests.
Doctors also use x-rays to accurately see the bones and joints. Although x-rays are reliable way of viewing the bone structure they are not accurate in identifying arthritis. Most people over the age of 65 have changes in their joints without having the accompanying joint pain, swelling and inflammation of arthritis. In fact, the cartilage and joint damage seen in an x-ray are often more severe than the patient's rating of pain and disability. The doctor will use x-rays with other findings and tests to identify the arthritic condition or modify a treatment program.
Doctors also use arthrography, a test in which dye is injected directly into the joint during a special x-ray procedure. The process is done in the radiology department, often by the radiologist. The test results are sent to the doctor and not given to the patient at the time of the procedure.
Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) are tests that physicians use to assist in the identification of joint degeneration or the involvement of soft tissue or other organs. The CT scan takes pictures in slices of the body and are then fed back to a computer for interpretation. These x-ray pictures show bone but also show muscle and organ systems as well.
The MRI uses radio waves in a magnetic field. The radio waves react with the water in the body and send back images to a computer. An adult is approximately 60% content so the MRI can be fairly accurate over the entire body. This test is the best for viewing soft tissue and organ system changes.
Sometimes doctors also use arthrocentisis to evaluate the fluid that is normally found in the joints. Synovial fluid analysis is done in a laboratory. In an inflammatory response this fluid can increase in amount and get thicker causing swelling of the joint.
Isotope Bone Scans are test done in the radiology department of the hospital. A small dose of radioactive isotope is injected into the blood stream and taken up by the bones. A special camera is used to see the bones and most accurately evaluate the inflammation in the joints.
In gout the fluid also has urate crystals - this is a conclusive test for gout. The lab will evaluate the thickness of the fluid. Because there is an increase of the synovial fluid which causes pain and swelling with arthritis, the removal of this fluid for the test will also decrease pain and improve mobility for a short period of time.
If the disease has progressed the doctor may recommend an arthroscopy, or a small surgical procedure in which an incision is made over the joint. A small tube and camera are inserted into the joint so the doctor can view the damage and sometimes also repair or remove cartilage. This surgery is done in the hospital, usually under a local anesthetic to reduce the surgical risk to the patient.
Some arthritic conditions also cause soft tissue and organ damage. One organ that can be affected are the lungs. Doctors will order Pulmonary Function Tests (PFTs) to assess any damage that may have been done. This will help to identify arthritis and modify treatment programs.
Another organ that can be affected is the heart muscle. An Electrocardiogram (ECG/EKG) is used to assess any muscle damage, help to identify problems and change treatment programs
Although there are no conclusive tests for arthritis, used in combination, these tests give physicians an accurate clinical picture to make a diagnosis. Without a correct diagnosis any treatment plan would not help to stop the progression of the disease or lessen pain, swelling and disability. To Identify arthritis the doctor needs a comprehensive physical exam, family history, testing and the cooperation of the patient.
No comments:
Post a Comment