Methods for diagnosing joint diseases. Which methods are better?

23.12.2019

Joint pain can be caused by autoimmune pathologies, inflammatory processes and infections, injuries, metabolic disorders and many other factors. A doctor can identify the main cause of unpleasant sensations only based on the results of a comprehensive diagnosis. The examination includes examination and palpation of the affected areas, medical history, instrumental and laboratory tests. Find out what studies and tests for joint pain will help a specialist make an accurate diagnosis and develop a treatment program.

Detailed description of the study

There are a large number of different joint diseases. Among them are often found: rheumatoid arthritis, gout, post-infectious joint damage. Inflammation in the joints is manifested by swelling, tenderness, redness and a local increase in temperature in the affected area. Patients often experience pain and impaired joint mobility. In the future, their deformation, destruction of cartilage tissue, and narrowing of the joint space may occur. Some diseases, such as rheumatoid arthritis, also have systemic manifestations: a person notices pathological weakness, fatigue, weight loss, and fever.

It can be difficult to make a differential diagnosis of joint diseases due to similar symptoms. Laboratory tests help establish the correct diagnosis.

This study contains two tests necessary to identify the cause of joint inflammation:

1. C-reactive protein;
2. Uric acid.

C-reactive protein (CRP) is one of many molecules involved in immune responses. CRP is detected in the blood of patients during various inflammatory processes and is considered a marker of the acute phase of their course. An increase in CRP levels is observed within the first four hours after tissue damage and reaches a peak after 24–72 hours.

The content of CRP during inflammation can be increased by 20 times or more. The most common joint diseases that are accompanied by increased CRP are:

1. Rheumatoid arthritis;
2. Gout;
3. Reactive arthritis.

CRP is also a marker of disease activity.

It should be noted that determining the level of CRP plays an important role in assessing joint inflammation, but is not a specific marker for this group of diseases. The indicator may reflect inflammation of another localization, including against the background of acute infections, injuries, and others.

Uric acid is one of the main products of protein metabolism in the human body. This substance is mainly excreted in the urine. When there is an excessive level of uric acid in the blood (hyperuricemia), deposition of its salts (urates) is observed with the formation of crystals. The latter are deposited in joints, subcutaneous tissue, and kidneys (where urates can form stones).

Gout is a systemic pathology, which is characterized by the accumulation of monosodium urate crystals in the joints, as well as other organs and tissues. An increase in uric acid levels suggests that joint inflammation is associated with the development of this disease.

Thus, this comprehensive study will help the doctor in differential diagnosis of the causes of joint damage and selection of therapy.

It is necessary to donate venous blood for analysis. Often the complex is prescribed in conjunction with other studies, such as general analysis and blood biochemistry, to check other organs and systems.

A detailed description of the studies and reference values ​​are presented on the pages with descriptions of individual studies.

What are joints

The human body has more than 200 joints that allow it to move.
They are located at the junctions of bones, where pronounced movements occur: extension, flexion, abduction, rotation, etc. Joints soften the friction of bones from each other and prevent destruction from mechanical stress. The joints consist of the following parts:

1. The articular surface is covered with cartilage, which softens shocks.
2. The bursa or joint capsule is a structure that is attached to the articular surface and protects the contents from mechanical injury and rupture. The fibers of ligaments and tendons are woven into it, so the bag reacts sharply to all destructive, inflammatory processes, which is manifested by pain.
3. Synovial fluid - found inside the bursa. It nourishes and moisturizes the joint and prevents wear and tear due to friction. If the fluid becomes inflamed, pain occurs.
4. The joint cavity is a hermetically sealed gap between the capsule and the surface. There may be intra-articular cartilage (menisci, discs) that act as a shock absorber.

In addition to joints, ligaments and tendons are actively involved in the movement of bones. Ligaments connect bones to internal organs or other parts of the skeleton. They contain a lot of nerve fibers, so stretching is always accompanied by pain. Tendons are structures made of collagen strands that attach striated muscles to the skeleton.

References

1. Rheumatoid arthritis. Clinical recommendations. Association of Rheumatologists of Russia, 2021. - 102 p.
2. Rheumatology: National Guide / ed. E.L. Nasonova, V.A. Nasonova. - M.: GEOTAR-Media, 2008. - 720 p.
3. Kishkun, A.A. Guide to laboratory diagnostic methods. - M.: GEOTAR-Media, 2007. - 800 p.
4. Internal diseases in 2 volumes: textbook / ed. ON THE. Mukhina, V.S. Moiseeva, A.I. Martynova, 2010. - 1264 p.
5. Kasper, D., Fauci, A., Hauseret, S. Harrison`s Principles of Internal Medicine 19/E (Vol.1). McGraw-Hill Education, 2015.

Diagnosis of joint diseases: types

To prescribe the correct treatment for the spine and joints, it is necessary to determine the causes of pain. It is impossible to accurately determine it using a visual examination; diagnostics are needed. Two methods are used:

• instrumental diagnostics - examination using various equipment (MRI or X-ray of the knee joint, ultrasound, etc.), which allow a detailed study of the condition of the damaged organ;
• laboratory diagnostics - general and biochemical analysis of blood, urine, study of synovial fluid.

Both methods complement each other, so they cannot be separated. The doctor will be able to see a clear picture only if he has blood test data, an X-ray, CT or MRI. Sometimes instrumental diagnostics can be limited to determining whether a sprain is visible on an x-ray. If the answer is positive, the limb is fixed and anesthetics are prescribed. Other tests are usually not needed.

Difference between MRI and ultrasound

Before we look at how MRI of joints differs from ultrasound, it is necessary to give clear definitions of each procedure.

Ultrasound examination is a diagnostic technique; scanning is carried out using ultrasonic waves. As a result, the doctor examines the condition of soft tissues and organs. The procedure is harmless. In this case, the doctor reads information about the condition of the meniscus, periarticular soft tissues, and cruciate ligament, but is not able to scan the bones and lungs. MRI is used to study bone tissue.

An MRI is a large magnet that produces magnetic waves within a specific magnetic field. During an MRI scan, the doctor examines all tissues and organs. The procedure can be used repeatedly and allows one to study the dynamics or consequences of an injury or disease. The question of which is better: MRI or ultrasound is not relevant. The difference is in information content, reliability and price.

Difference between X-ray and ultrasound

X-ray scanning is used in traumatology; during the examination, bone tissue pathologies are identified. During the ultrasound scanning process, the condition of bones, ligaments, cartilage, synovial bursa, and articular surfaces is assessed.

The advantage of ultrasound diagnostics is that it is harmless to the human body. X-rays affect the body with ionizing radiation and are prohibited for pregnant women. The radiation exposure received during the examination is taken into account.

In what cases should you contact a specialist?

The therapist will tell you what kind of specialist this will be, depending on the clinical picture. But you definitely shouldn’t hesitate to contact us if you have the following symptoms:

• injuries of any severity - fractures, dislocations, damage to joints and soft tissues;
• chronic rheumatic diseases (the doctor must monitor the dynamics and effectiveness of therapy);
• sudden onset of pain in the joint;
• other alarming symptoms regarding the musculoskeletal system.

Approximately as shown in the video, an initial appointment with an orthopedic doctor takes place:

X-ray method

The easiest and most accurate way to diagnose arthrosis is with an X-ray. It will show signs characteristic of one or another stage of the disease:

• Stage 1. The image does not yet show bone growths, but the surface of the joint is uneven, sometimes with slightly ossified areas. The joint space is slightly narrowed, so external symptoms are not yet pronounced.
• Stage 2. Bone growths are already clearly visible, the gap is approximately 2-3 times narrower than normal. The specialist notes subchondral sclerosis - one of the signs of arthrosis, hardening and proliferation of bone tissue.
• Stage 3. The picture does not show the joint space at all. Most of the articular surface has ossified and increased due to marginal growths. One of the signs is a “joint mouse,” the movement of a fragment of the meniscus, cartilage or bone, which radically limits motor activity.

Only x-rays can accurately determine the degree of arthrosis

Basic modern techniques

Diagnosis of diseases of the knee joint, as well as their traumatic injuries, is aimed at visualizing its structures using several common methods, which include:

• Radiography.
• Computer or magnetic resonance imaging.
• Ultrasonography.
• Arthroscopy.

The choice of research method is determined by the results of a clinical examination, during which the doctor pays attention to the symptoms of the disease and the circumstances of the injury. The list of procedures and tests is also determined by the technical capabilities of the clinic.

CT scan

An X-ray research method that has high resolution and makes it possible to visualize even minor pathological changes in the knee is called computed tomography. Using special equipment, layer-by-layer scanning of tissues is carried out, after which digital processing of the resulting images is performed on a computer with 3D modeling of the structures.

Computed tomography is used to diagnose pain in the knee joint, the development of which has an unclear origin. Also, using CT, visualization of the ligamentous apparatus is performed. This diagnosis of the knee joint ligaments makes it possible to identify small tears in individual connective tissue fibers without violating the anatomical integrity.

Diagnosis of the meniscus of the knee joint is performed if a traumatic or pathological injury is suspected.

Radiography

Radiography
One of the most common methods of visualizing the structures of the knee, which is used for the primary diagnosis of injuries to the knee joint, is radiography. The essence of the technique is that X-rays are able to penetrate the tissues of the body. In this case, on X-ray film or a special screen, the doctor can see dense structures (bones, ligaments), through which X-rays pass less well.

To obtain a better result, radiography is performed in frontal and lateral projections. This imaging method cannot detect small changes, so other methods are often used in addition. X-rays are used to diagnose damage to the meniscus of the knee joint, fractures or dislocations.

Causes of Arthritis

The real causes of rheumatoid arthritis are still not clear. It is only known that the disease occurs when the immune system “fails.” In other words, the immune system begins to “fight” its own cells, causing disturbances in the body.

There are suggestions that the following factors can trigger rheumatoid arthritis of the joints:

• past infectious diseases (measles, hepatitis B, mumps, herpes);
• genetic predisposition (special genes, for example, DRB1 provoke “immune errors);
• hypothermia of the body;
• injuries;
• consequences after surgical operations;
• food allergy.

Which doctor treats hand joints?

If you have problems with the joints of your hands, then your disease is most likely associated with damage to the cervical spine, nerve impulse pathways, or cartilage tissue.

Contact your healthcare provider if you experience any of the following symptoms:

• Neurologist. Painful sensations in the wrist joint and fingers at the end of the working day
• Osteopath or orthopedist. When you move your hands, crunching and clicking sounds appear. Feels limited mobility, stiffness in the morning
• Chiropractor or osteopath. Sharp pain with any movement, trying to raise your arms or bend them at the elbows
• Orthopedist, osteopath or chiropractor. Pain in one or more joints of the arm, decreased muscle strength, difficulty performing normal movements

Where to go?

Do you want to get tested at the clinic on Nakhimovsky Prospekt? Contact ENEL-CLINIC. We see experienced specialists who develop an individual diagnostic and treatment program for each patient. You will be able to undergo various tests and get consultations with doctors at a convenient time, without queues or waiting.

We are located in the Nagornaya metro area. It is more convenient to travel by car from Sevastopolsky Avenue. You will find the exact address and telephone number in the “Contacts” section.

Additional instrumental methods

Sometimes other methods are prescribed to clarify the diagnosis. They have a number of contraindications due to their invasiveness, are quite expensive and are rarely practiced.

• Arthroscopy. An early diagnostic method that allows you to detect changes in cartilage tissue, even if they are not yet visible on an x-ray. It is performed under local anesthesia for 30-60 minutes. It has high diagnostic accuracy and minimal risks of complications.
• Chondroscopy. A type of arthroscopy, the purpose of which is to study the condition of the cartilage, namely the degree of its damage. Most often used to evaluate the effectiveness of treatment with chondroprotectors for arthrosis.
• Osteoscintigraphy. A type of radionuclide diagnostics that involves the introduction of a radiopharmaceutical into the body to detect bone pathology.

Arthroscopy is a highly informative visual diagnostic method using an arthroscope

Diagnosis of arthrosis is often difficult because external symptoms are not so obvious and overlap with signs of other joint diseases. There are a number of instrumental and laboratory methods that allow you to make an accurate diagnosis. You should not ignore the specialist’s recommendations regarding the examination, because the correct choice of treatment tactics, and therefore the result, depends on this.

When to go to a rheumatologist

In fact, the profile of a rheumatologist is very wide and includes several dozen diseases and pathologies. For example, a predisposition to sore throats and viral diseases may have a rheumatological cause. Of course, there are certain age indicators, but if you are young and rule out the possibility of injury, then the reason to contact a rheumatologist is pain, discomfort, or some changes in the structure or shape of the joints. Especially if all this is accompanied by fever, unexplained weight loss, and changes in blood tests. In this case, the process cannot be delayed. Contact your rheumatologist directly to get into the “therapeutic window.”