Diagnosis of rheumatoid arthritis, examinations for rheumatoid arthritis

To clarify and confirm the diagnosis, as well as to determine the severity of rheumatoid arthritis the following studies are usually prescribed: x-ray of the hands and feet, finger prick blood test (clinical blood test) + blood test from a vein (for rheumatoid tests).

Usually, in the advanced phase of rheumatoid arthritis, specific signs of the disease are clearly visible on x-rays: in the wrist joints, the joint spaces “melt”, that is, the distance decreases and the boundaries between the small articulating bones of the wrist become blurred. And “uruses” appear in the fingers and toes, that is, erosions of the bones occur in the area of the metacarpophalangeal and metatarsophalangeal joints. This is a very characteristic sign of this disease.

In the most severe cases, we can see on x-ray the fusion of the joint bones with each other. This fusion is called “ankylosis”. With ankylosis, joint mobility is practically absent.

In a blood test taken from a finger prick , in rheumatoid arthritis, we usually detect an increase in ESR (ER) above 20–25 mm/hour, with an active rheumatoid process - even above 40 mm/hour. This sign indicates the presence of an inflammatory process in the body. However, I draw your attention to the fact that ESR (ROE) can be increased with any inflammation, and not only with the rheumatoid process.

ESR (ROE) - erythrocyte sedimentation rate (reaction) is an important indicator of inflammation in the body. If human blood is placed in a glass tube and secured in a vertical position, then the red blood cells, which make up the bulk of blood cells, will settle, leaving a column of clear liquid at the top. In a healthy person, red blood cells settle slowly. And the development of inflammation is accompanied by an increase in sedimentation rate. This is due to changes in the protein composition of the blood.
To date, ESR remains the most reliable laboratory indicator of the degree of inflammation. In addition to ESR, several biochemical parameters reflecting disease activity (C-reactive protein, fibrinogen, seromucoid) are often determined. Together they allow us to give a more reliable assessment of the patient’s condition. The listed tests are used for almost all inflammatory rheumatic diseases.

In a blood test taken from a vein , we often detect in rheumatoid arthritis an increase in the listed “inflammatory markers”: increased levels of C-reactive protein, seromucoid, fibrinogen, immunoglobulins, etc.

“Inflammation markers,” like ESR, also indicate the presence of inflammation. Including, possibly, rheumatoid. But an increase in their level again does not allow us to reliably confirm the diagnosis of rheumatoid arthritis, because “inflammatory markers” also react to other inflammatory diseases of the joints. That is, all of these are nonspecific signs that only allow us to narrow the circle of the diagnostic search.

A specific sign of rheumatoid arthritis is considered to be the detection of rheumatoid factor . Having discovered rheumatoid factor, many doctors immediately, without any doubt, diagnose the patient with rheumatoid arthritis. And they forget one circumstance: rheumatoid factor is found in the blood in other diseases. It is even found in the blood of completely healthy people (about 5-7% of healthy people). Therefore, this sign cannot be absolutely reliable. Just like its absence: in half of patients with rheumatoid arthritis, rheumatoid factor is not detected.

Therefore, rheumatoid factor is important, but still just an additional sign of the disease. And the diagnosis is established only by the totality of all clinical symptoms and changes in the x-ray of the joints, supplemented by a number of indicators from blood tests.

READ MORE:

Symptoms of rheumatoid arthritis
Causes of rheumatoid arthritis
No more medications needed?
All articles by Dr. Evdokimenko

How are rheumatoid arthritis and anemia related?

Cold hands may be a symptom of anemia

Scientists from Donetsk National Medical University named after. M. Gorky conducted a study, the results of which showed that from 30 to 70% of patients with rheumatoid arthritis experience anemia.

People with rheumatoid arthritis may be affected by different types of anemia. Below are some of them.

Anemia of chronic diseases. This problem develops in people with inflammatory disorders. Sometimes the body with this condition does not produce enough red blood cells, or the cells do not live as long as they should.
Hemolytic anemia. This medical condition occurs when the body destroys healthy red blood cells due to immune system disorders, infection, or a reaction to certain medications.
Iron-deficiency anemia. This type of anemia occurs when the body does not have enough iron to produce red blood cells. Sometimes this is due to a lack of iron in the diet, although often the cause of the problem is poor absorption of iron by the body.
Megaloblastic anemia. This anemia is characterized by red blood cells growing too large. Overly large red blood cells are unable to carry oxygen as efficiently as healthy cells.

Some people have a combination of iron deficiency anemia and anemia of chronic disease.

How Rheumatoid Arthritis Causes Anemia

Rheumatoid arthritis can lead to anemia in a variety of ways.

ESR in rheumatoid arthritis - Orthopedist.info

One potential cause is the medications people take to treat rheumatoid arthritis. These include, in particular, steroids and methotrexate. Such drugs can cause damage to the intestinal mucosa, as a result of which the body's ability to absorb iron deteriorates, and this leads to the development of anemia.

Some people with rheumatoid arthritis may take drugs to suppress the immune system, such as azathioprine or cyclophosphamide. Side effects of these medications include decreased production of bone marrow, which produces red blood cells.

Sometimes rheumatoid arthritis shortens the lifespan of red blood cells. This effect can also lead to anemia if the body is unable to produce new red blood cells at a fast enough rate.

It is critical for patients, and especially physicians, to understand the above connections between rheumatoid arthritis and anemia. Doctors can only recommend the most effective treatment if they know the underlying cause of the problem.

Diagnostic methods

To establish the cause of poor health with severe manifestations of RA, a number of studies are carried out to determine the presence of anemia:

To identify the causes of the pathology, an ultrasound of the internal organs may be prescribed.

General blood analysis. Establishes the quantitative ratio of elements, determines the morphological structure of red blood cells.
Blood chemistry. Determines the level of iron and hemoglobin.
Ultrasound of internal organs. It is carried out to identify concomitant pathologies.
General urine analysis. Determines kidney functionality.
Radiography. Determines the severity of rheumatic joint damage.
MRI and CT. Determine minimal changes in the structure of organs and systems.

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Symptoms

Poor concentration may indicate the presence of pathology.
In addition to the signs of arthritis, which include: joint pain, hyperemia and swelling of tissues, impaired mobility, fever and increased temperature, patients with RA with concomitant anemia experience the following symptoms:

decreased performance;
impaired concentration;
weakness;
dizziness;
lowering blood pressure;
cooling the skin of the fingers and toes;
muscle weakness;
breathing problems;
change in heart rhythm;
relapses of viral diseases;
changes in the condition of the hair and nail plate;
With severe iron deficiency, fainting is possible.

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Prevention

To prevent the development of anemia due to RA, you need to follow your doctor’s recommendations for treating the underlying pathology. It is important to periodically monitor the quantitative ratio of blood elements. It is recommended to take iron-containing foods and vitamin-mineral complexes. If additional causes of blood loss arise, procedures must be immediately carried out to eliminate them.

Bibliography:

https://medmaniac.ru/revmatoidnyi-artrit-i-anemiya/
https://etosustav.ru/vospalenia/inoe/anemiya-pri-artrite.html
https://medaboutme.ru/articles/aplasticheskaya_anemiya_pri_revmatoidnom_artrite_chto_eto/
https://osteokeen.ru/at/vazhno/anemiya-pri-artrite.html

Treatment of the disease

The mainstay of treatment for anemia is therapy with anti-inflammatory drugs, including immune response modifiers (biologic agents), which are needed to stimulate the natural response to inflammation. An effective approach is the use of monoclonal antibodies to interleukin-6, a pro-inflammatory and anti-inflammatory cytokine that promotes the development of anemia. Also, glucocorticosteroids, which have an anti-inflammatory effect, are prescribed to cure the disease.

If standard treatment of the underlying disease is not possible, then alternative methods are considered. For example, in cases of severe or life-threatening anemia, treatment is replaced with fluid-transfusion therapy or treated with recombinant human erythropoietin. The use of iron-containing drugs should be treated with caution, because on the one hand, they counteract the activation of the disease, and on the other, iron is an excellent substrate for cancer cells and various microbes; its ions are involved in the formation of hydroxyl radicals, which in some patients causes endothelial dysfunction and increases the likelihood of cardiovascular complications.

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Diagnostics

If you suspect low hemoglobin, your doctor will order a blood test to find out the following parameters:

Studying anemia in arthritis involves taking blood tests for various diagnostic methods.

hemoglobin level;
red blood cell count;
reticulocyte count, to measure new immature red blood cells;
serum ferritin (iron-containing protein) and iron levels.

To diagnose iron deficiency, in addition to obtaining typical ferrokinetic and hematological data, the saturation of soluble transferrin protein receptors (the main iron carrier in the blood plasma) is determined and the mathematical index of ferritin is calculated, as well as the level of erythropoietin contained in the blood serum. Such methods make it possible to study and understand the pathogenetic causes of anemia.

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Why anemia develops with arthritis: reasons

The disease occurs when the bone marrow produces less than the body needs of the red blood cells (RBCs) that carry oxygen throughout the body. The lower the number of circulating cells, the more the body experiences oxygen starvation. Anemia is quantitatively expressed by the degree of decrease in the concentration of hemoglobin (the iron-containing pigment of red blood cells responsible for the red color of blood).

Anemia in rheumatoid arthritis is an extra-articular manifestation of chronic inflammation, a concomitant disease, or a complication caused by therapeutic treatment.

Aggravation of arthritis causes severe inflammation in the joints and leads to dysfunction, resulting in anemia. Then the patient:

the production of red blood cells in the bone marrow decreases and overproduction of hepcidin, a protein that lowers the level of iron in the circulating blood, begins;
there is a shortening of the life span of red blood cells associated with the increased activity of the reticuloendothelial system, which protects the body from microbial infection and removes old cells from the circulating bloodstream;
phagocytosis—the process of absorption of foreign microelements by phagocytes—intensifies;
the reproduction of erythropoietin, a hormone that controls the production of red blood cells, is disrupted.

Anemia in arthritis is sometimes caused by medications.
Some medications used to treat rheumatoid arthritis cause anemia. They have a toxic effect on bone marrow and blood cells. According to statistics, low hemoglobin is detected in 30-70% of people suffering from arthritis. Most often, iron deficiency anemia and anemia in chronic diseases accompanying infectious, rheumatic and oncological diseases are observed.

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Therapeutic measures

First of all, treatment is aimed at eliminating the underlying disease in the form of RA. Non-steroidal anti-inflammatory drugs and analgesics are used to relieve pain. Corticosteroids are used to reduce the severity of inflammation. Drugs are used that are aimed at suppressing the activity of the immune system in the form of antirheumatic drugs.

Treatment of anemia is symptomatic. For severe iron deficiency, the following drugs are used:

Hemobin will help replenish iron deficiency.

"Sorbifer Durules";
"Ferlatum";
"Fenuls";
"Hemobin";
"Conferon";
"Feramid";
"Totema".

The disorder caused by chronic inflammation is treated with recombinant erythropoietin. For better absorption of iron-containing components, vitamin C is prescribed. In order to normalize the ratio of components, vitamin-mineral complexes are used. Injections of vitamin B2, B6 and B12 are prescribed in combination with folic acid. Walking in the fresh air and stabilizing your emotional state help normalize hemoglobin. Particular attention is paid to nutrition. The diet includes beef liver, legumes, pomegranates, buckwheat, vegetables, fatty fish, dairy products and dried fruits.

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Cause of anemia in arthritis

More than 60% of patients diagnosed with rheumatoid arthritis (RA) exhibit anemia, leading to oxygen starvation of tissues, dysfunction of internal organs and aggravation of the underlying disease. According to statistics, more than 40% of cases of anemia with rheumatoid lesions are a consequence of iron deficiency and almost 60% develop in response to chronic pathology.

Impaired iron utilization leads to a decrease in iron levels in the blood. The reason is the retention of the element in the immune system, which in the rheumatoid form of arthritis is characterized by hyperreactivity. Part of the component binds to proteins that transport them to the bone marrow. In RA, iron remains in the immune system's reserves but has no effect on bone marrow tissue. Against the background of the pathological process, the amount of the substitute - ferritin, which is a protein and practically does not contribute to metabolism, increases.

Chronic inflammation is considered the main cause of anemia in RA. Moreover, its severity depends on the clinical activity of the disease, and not on the duration of the pathology.

A bleeding stomach ulcer is one of the causes of the pathology.
Another cause of anemia is considered to be true iron deficiency caused by blood loss against the background of bleeding from ulcerative lesions of the gastrointestinal tract, which occur as a result of long-term use of non-steroidal anti-inflammatory drugs. Anemia in rheumatoid arthritis also develops due to the use of specific medications, which slow down the synthesis of lipid physiologically active substances.

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Development mechanism

Under the influence of inflammation, the quantitative ratio of elements is disrupted. The level of leukocytes increases and hemoglobin decreases. Inflammation in rheumatoid arthritis is aggravated by intoxication that occurs when decay products accumulate. Against this background, there is destruction of red blood cells, from which iron-containing elements are released and sent to transport proteins. Their compounds enter the organs of the defense system, but due to the development of a pathological condition, they are not absorbed, but accumulate, which leads to a deficiency of nutrients in the bone marrow.

The changes that occur during rheumatoid damage to the body disrupt the synthesis of proteins, hormones and other important elements involved in metabolism and hematopoietic processes. This condition causes a deficiency of blood components and causes anemia, which affects the functionality of organs and systems.

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