Arthritis Information -Criteria for diagnosis of RA

The following information was taken from http://www.geriatricsyllabus.com/syllabus/main.jsp?cid=SCC-M SK-4-2 if your interested in the information and want to look at the site. It has lots of information about several other simular conditions as well.

The criteria for the diagnosis of rheumatoid arthritis (RA) are the same for older and younger persons:
1998 revised American College of Rheumatology criteria for classification of rheumatoid arthritis. Patients should have at least 4 of the 7 criteria, and the first 3 must have been present for 6 weeks or more

CRITERIA	DEFINITIONS
Morning stiffness	In and around the joints, prolonged (lasting at least 1 hr before maximal improvement)
Arthritis of > 3 joint areas	Inflammatory soft tissue swelling or fluid in at least 3 joint areas simultaneously, observed by the physician. This reduces the joint spaces
Arthritis of hand joints	At least one joint involved in the hands
Symmetrical arthritis	Simultaneous involvement of joints on both sides of the body
Rheumatoid nodules	Aggregates of inflamed subcutaneous tissue cells which collect over bony prominences or extensor surfaces, or in juxta-articular regions, as observed by a physician. The skin is thin and fragile above the nodules.
Severe rheumatoid factor	(rheumatoid factor is an antibody to the Fc portion of IgG and may be responsible for amplifying the inflammatory response in the synovium) Abnormal levels should have been measured by any method that has been positive in less than 5% of normal controls
Radiographic changes	Classic changes must include erosions or unequivocal bony decalcification, localized or most marked adjacent to the involved joints. Osteoarthritis changes alone do not qualify

Involvement of joint sites in established rheumatoid arthritis
Note that late-onset RA is:

Less likely to show hand pathology
More likely to show shoulder and hip swelling
Less likely to be rheumatoid factor positive.

Not all the features of RA are present initially, as many develop over time.
Note too that:

About 20% of older people have a coincidental increase in rheumatoid factor
Other diseases, including systemic lupus erythematosus, chronic lung disease and chronic liver disease are associated with elevated titers of rheumatoid factor.

Once the diagnosis has been confirmed, the severity needs to be considered to inform management decisions. The core data to be determined from clinical assessment have been internationally agreed and are:

Number of swollen joints
Number of tender joints
Pain assessed by the patient
Patient's global assessment of disease activity
Physician's global assessment of disease activity
Laboratory evaluation of an acute inflammatory phase reactant (e.g. C-reactive protein)
Self-administered functional assessment e.g. the Health Assessment Questionnaire (HSA), the Arthritis Impact Measurement Scale (AIMS).

These measures give a good overall picture of RA and permit assessment of progression and response to treatment. I do not have symmetrical joint problems, but I have all the other symptoms. It effects my left ankle, right knee, hips, right elbow and right wrist the worst.

As of about 4 or 5 months, all pain is now gone except right wrist. Yay... I LOVE enbrel and methotrexate. I have weaned off of Prednisone and have almost weaned off of relafen. I only take it when I can feel swelling start to come on. Currently working on weaning from MTX!

Bumping this up for some of our newbies....this is important information for anyone in doubt.

What amount of MTX do you take Butterfly?Lovie- I have been on MTX for almost a year I think. I went off of it for a while, hoping the Enbrel could do all of the work, but ended up going back onto it to help boost the Enbrel. Sometimes it is an elixir that will work. I have been almost pain free for 2 months (an Arthritis sufferer's definition of pain free will be a lot different than a regular persons definition- so I am sure you know what I am mean.) I still have slight pains here and there. In about another 2 months, I will start cutting back the MTX. As you can see in my siggy, I finally got off the Relafen and it didn't make me flare. I haven't taken a single dose or shot of pred. either since AUG. and pray I never have to go back! How long have you been using MTX?[QUOTE=Lovie]What amount of MTX do you take Butterfly?[/QUOTE] My name is Shelby. My Doctor wants me to go on Methotrexate and I am afraid. Does anyone have any advice for me? Is it worth the side effects? My RA is getting worse.Hi Shelby. I am going to start MTX this week. I am waiting for a call giving me the go after my liver test results.

I have heard that it exhausts you, so I plan on taking it on Friday nights. I have read up on it extensively online to understand what it does. The side effects will be different for different people.

My mom has been on it for many years and does really well with it. She takes milk thistle to help with the liver funciton, but that would be something you should be sure to talk to your doctor about first.

Moving back to the top as this is a Very important link.

If you're reading this and it's moved back several pages bump it up to the top by posting.

Thanks.

Lovie

thanks for the information

Kelly~We seem to have little to no interaction from the "Mods" here. We have no idea who they are even....that's one reason we keep kicking this thread back up to the top.

Welcome to both you and estrutter. Come join the rest of the gang in the RA forum. Even those that don't have RA visit there most often because that's where every one visits most.

Hope to see you both on a regular basis. Sorry it took me so long to find you.

Sadly; this area gets over looked a lot more often than it should.

bump....please continue to move this thread back to the top. It's a very important thread for this section.Yes it is! 6 outa 7 baby....haha It's a game...but I'm pretty sure I wouldn't win...dang..nevermind. Anyone know how common it is to have everything but the blood-work show you have RA?

Yeah, good thread. I'm pretty sure I meet all those criteria, although I'm not sure what my "rheumatiod factor" is and I don't know anything about "radiographical changes" or whatever. Also, I don't think I'm 100% sure what a "nodule" is. Maybe someone could explain that to me.

Take care all,

Jesse

Isn't radiographical changes are what they see on x-rays? I have mine in a mega envelope here at the house, and they are quite interesting...

I haven't had any x-rays taken in a while. They kind of creep me out. Especially mine cause they're so weird looking. Bones all twisted up and all the metal here and there from the joint replacements. Crazy.

So no, haven't had an x-ray in a while, but I have to go in for a PET scan tomorrow (like a CAT scan, but more detailed and modern). Have to check and make sure my tumor isn't coming back. Routine check-up.

So wish me luck.

cat scan...pet scan....are you sure you're not visiting a vet?

Im kidding.

and of course, GOOD LUCK!

Yes; that would be the x-rays or MRI's I suppose. Sounds like you've got that too for sure Skin. I'll keep my fingers crossed that the PETS test comes back clear.

Arriscolwell~My blood work is normal except for the occational elevated SEDS Rate. I pretty much have the rest of them execpt for the nodules; which are lumps that develope over time.

Whats SED rate? I'm thinking since I don't recognize it, it's never been an issue for me. All I know is, everytime the took my blood, they always joked about how they should have just used the last vial the took, cause nothing ever changes in it. O.o Whatever that means. I haven't had a blood test done since I was about 12. They just kinda quit doing it. I suppose that's a good thing!

SEDS rate is a test they do for inflamation. It shows the amount of inflamation in your system. Mine is occationally elevated.

What meds are you on? If are on strong RA medications it's very important that you have your blood checked on a regular basis. If your doctor is not doing this he should be.

Even antiinflammatories like large doses of Advil can cause serious issues with your kidneys and liver and a quick blood test can alert the doctors to this before it's too late.

Often once your liver is affected you once be able to take hardly any medication....make sure you ask your doctor about this. Are you currently seeing an RD?

I know you mentioned having JRA and just recently started having problems again. Have you started seeing a doctor?

Nope, I haven't seen a doc since I was 17. :/ And I only take OTC naproxyn. (whatever its called) heh. The last med I was on was Vioxx, and before that was Celebrex, but it didn't really do anything. Aside from that the only other med I've ever taken is ibu. I took that for 11 years. Age 3-14. But I don't recall them ever being concerened with my blood work. How would you know if you liver has been affected otherwise?

I'm not sure ou would until it got to a critical level. Even with regular use of IBU you should have your blood tested by an RD for problems. It can be quite harmful to your kidneys as well.

I'd suggest searching for an RD considering your history and your recent increase in symptoms.

I haven't been taking a lot of it, and I don't have insurance right now. Soo....well...I dunno. Heh outa luck for now.

I understand that delima all too well. I was there for a long time when I was younger.

If I had any advise for you I'd say look for employment that offers a good health plan.

My insurance is paid 100% through by my employer and that is like adding ,644 to my salary every year. It also pays for more than ,000 in medication every year.

RA is a very expensive disease. Without good health insurance I would never be able to treat it properly.

I work for Embassy Suites, I'm not eligable for insurance until Feb, and no one seems to be able to give me any price information on it. They kinda suck like that.

Definately look into it once you become eligable. It wil be well worth it even if you have to pay a portion of it.

You might not need it right now as muc as you might need it in the future.