Rheumatoid Arthritis: Making the Diagnosis

The physician may order lab tests to determine presence of an inflammatory process in the body, the RA factor, complete blood count, an analysis of the synovial fluid, and a urinalysis. A hepatic panel may be required to determine liver and pancreatic function. These tests provide a baseline and insight into the patient's general health.

A neurologic evaluation includes assessment of the patient's symptoms, including motor and sensory function, pain, numbness, paresthesias, muscle spasm, weakness, and bowel/bladder changes.

Radiographs (x-rays) are taken of the cervical spine. These x-rays are used to assess the joints, vertevral end plates, subluxation, narrowing of intervertebral disc spacing, osteophyte formation, and general structure. The degree of joint space, malalignment, or deformity is measured using radiographs. A myelogram-enhanced MRI or CT Scan may be performed to determine and evaluate spinal cord compression.

Sample X-ray of the neck; does not illustrate RA

Glossary

Joints: In the spine, RA usually affects the cervical spine. The joints in the upper cervical spine include the odontoid process, a tooth-like structure that rises from the body of the axis (second cervical vertebra). The odontoid moved anteriorly (front) with the atlas (first cervical vertebra). The joint space between the axis and the atlas is termed atlantoaxial. The lower cervical spine includes the lateral (side) joints termed zygapophyseal or facet joints.

Motor: Response to a stimulus, such as a nerve signal, to a muscle to contract.

Myelogram: A diagnostic test to identify spinal cord lesions. The subarachnoid space of the spinal cord is injected with a contract medium, followed by x-rays.

Myelopathy: Disturbance of the spinal cord.

Osteophyte: A bony overgrowth, bone spur.

Paresthesias: An abnormal sensation such as tingling, burning, or pins and needles.

Paraparesis: A slight to moderate degree of paralysis in the lower extremities.

Sensory: Relating to sensation: feeling, pressure, temperature.

Subluxation: An incomplete dislocation, or altered contact between joint surfaces.

Vertebral End Plates: The upper and lower plates of the vertebral body adjacent to the intervertebral disc.