Rheumatology is a specialty devoted to the study of rheumatic diseases and disorders of the musculoskeletal system, which account for about 10% of all visits to primary health care departments. Diagnosis of rheumatology usually includes a complete medical history, physical examination using classification criteria and, if indicated, laboratory and imaging studies.
Patients with rheumatic diseases are present in doctors with many different complaints. Although signs and symptoms can be localized and specific to a specific diagnosis, in many cases the symptoms are poorly defined and the physical diagnosis is very subtle.
Diagnosis of rheumatology
Rheumatic diseases lend themselves well to a systematic approach to diagnosis, based on the demography and structure of muscles, joints, and organs. For example, a young woman with diffuse joint pain and a zygomatic rash should be suspicious of systemic lupus erythematosus, while a painful first metacarpal joint of an acute onset should be diagnosed with gout.
When an individual patient comes with a complaint of the musculoskeletal system, pain is usually the driving force. An important aspect of physical examination is to determine the symmetry of joint involvement, the number and location of affected joints, as well as the presence of inflammation.
The regimen of onset and development of symptoms over time is very useful for establishing the correct diagnosis. For most chronic arthropathies, such as rheumatoid arthritis, the onset is usually subacute, occurring from several weeks to several months, and not from several hours to several days. On the other hand, attacks of gout and septic arthritis are acutely felt, reaching a peak within a few hours.
Diagnostic and classification criteria.
Since most rheumatic diseases are syndromes without specific diagnostic signs. It is critical to establish criteria that ensure uniformity in diagnosis, classification and epidemiological studies. For most rheumatic disorders, disease-specific criteria have been developed that have significantly influenced the practice and progress of rheumatology.
In short, the classification criteria are designed to distinguish patients with the disease in question from those who do not have the disease. Some experts advocate the use of diagnostic criteria as a valuable survey tool for primary health care. Especially when looking for patients in the early stages of rheumatic conditions.
Criteria for evaluating disease activity have also been developed, such as DAS-28 for rheumatoid arthritis or SLEDAI for systemic lupus erythematosus. They are useful not only in research conditions but also in everyday clinical practice. Because treatment can be adapted to achieve maximum disease control in an objective way.
Laboratory research and image research.
With careful use, laboratory tests can be very specific and significantly contribute to establishing the correct diagnosis. The basis of an early examination is to determine the rate of sedimentation of red blood cells (ESR). As well as C – reactive protein (CRP), which are both part of the acute phase reaction.
Antinuclear antibodies (ANA) are present in a wide range of autoimmune and connective tissue diseases. Although almost all patients with systemic lupus erythematosus are ANA-positive, a large number of cases of false positives make it difficult to use it as an examination test. Rheumatoid factor (RF) is commonly used in the diagnosis of rheumatoid arthritis, but its sensitivity varies depending on the patient population.
New tests, such as a cyclic citrullinated protein antibody, are being introduced to improve early identification of patients with rheumatoid arthritis, namely with a prognosis of more aggressive disease. In addition, it was shown that anti-keratin, anti-RA33, anti-p68 and autoantibodies were shown to be more than 90% specific for this disease.
Diagnosis of rheumatology