Rheumatoid Arthritis #1: Early Diagnosis & Self-Check

Doctor's Insight.

Hello and welcome to Doctor's Insight.

Rheumatoid arthritis, or RA, is a disease in which immune cells, that normally work to protect our body, mistakenly attack healthy cells,

especially the synovial membrane surrounding the joints.

When RA is left untreated, the disease progresses and further destroys bones and cartilage, causing joint deformities.

It is said that 1 in every 100 people in Europe and the United States suffers from rheumatoid arthritis, and the number continues to increase each year.

In Japan, the patient's onset age peaks in the 40s, and 80% of patients are women.

Moreover, the cause of the disease is not clearly known, and anyone can be affected by RA.

So, how can you find out if you have rheumatoid arthritis?

Today, we will introduce ways to detect RA early.

Today's expert is Professor Kaneko Yuko from Keio University.

Her motto is to provide treatments that suit the patients' lifestyles.

Dr. Kaneko, thank you so much for joining us today.

Thank you for having me.

I understand that rheumatoid arthritis is a disease that destroys the joints, That could cause all kinds of challenges in our day-to-day lives.

Yes.

Joints are located all over the body, and problems caused by rheumatoid arthritis range depending on the severity.

It can be pain and stiffness that makes it difficult to button your clothes.

Or, it could be pain in the knees, legs, and feet that make it difficult to walk properly.

As the condition progresses, joint deformity makes the problems more serious.

That's why it's important to detect the disease in its early stages before it becomes serious.

That means, we need to suspect the possibility of RA in order to detect it early.

Are there any early signs we can catch?

Yes, there are several distinctive symptoms of rheumatoid arthritis.

In the early stages, symptoms such as pain and swelling often begin in small joints such as fingers, wrists, and toes.

Gradually, the symptoms appear in larger joints such as the shoulders, elbows, hips, knees, and ankles.

So that's really all over the body— and it's typical for the symptoms to start in the small joints.

Yes.

And in the fingers, patients rarely feel the symptoms in the first joint.

Pain and swelling are likely to occur in the second joints and at the base of the fingers.

I understand what to look out for.

If we see any of these signs, we should have a doctor look at them immediately for early detection.

Doctor, why do people develop rheumatoid arthritis in the first place?

Genetic factors and environmental factors are both involved.

Well-known environmental risk factors are smoking and gum disease.

Scientists are also starting to suspect the link between gut microbiome and rheumatoid arthritis, but we still don't know the clear causes.

Rheumatoid arthritis is in fact a difficult disease to diagnose.

People who think they can get definite results by going to a hospital, need to be aware of the pitfalls.

Here are some tips for improving health literacy as a patient.

Take a look at the following case and think about where the pitfall is.

Thanks for meeting with me today.

I've been experiencing a lot of pain in my wrist lately.

It's hard to move my fingers, too, because of the pain.

Let's take a look.

I see...

There are many possibilities, so let's conduct a thorough examination.

The doctor decides to examine the cause of the pain with X-rays and blood tests.

However, the X-rays showed no abnormalities in the bones.

The blood test also came out negative for "rheumatoid factor" and "anti-CCP antibodies," which are usually positive in patients with RA.

The test did not indicate any detailed results.

It could be tendonitis, which is an inflammation of a tendon that cannot be detected by X-rays.

Do you remember overusing your hands recently?

Let me think...

Uh...well.

I guess it could be from overuse.

But, we can't make any definite diagnosis just today.

You're going to need to continue to pay attention to your wrist and come back regularly for checkups.

Okay.

However...

Not only did the pain NOT go away, it developed in the other wrist and further spread to the fingertips.

But since the initial results of the patient's rheumatoid factor and anti-CCP levels had been below the threshold, she had neglected to go in for regular checkups.

If it's tendonitis, they'll just end up giving me some pain relievers.

So I'll just deal with it by taking the painkillers I have at home.

For one year, the patient lived her life dealing with the pain using painkillers.

When the pain spread to her knees and shoulders, the patient finally went to see the doctor.

After another round of tests, they found that the bones were beginning to erode and the level of inflammation found in the blood tests turned out to be very high.

It was not tendonitis, but, rheumatoid arthritis.

Doctor, how could this have happened?

Rheumatoid arthritis could be difficult to diagnose in its early stages unless the doctor specializes in RA.

Patients should also avoid making their own judgments and skipping medical examinations.

But if you are told that both the X-ray and the blood test came out normal, is there any reason to suspect rheumatoid arthritis?

That's the major pitfall.

We look for damage of the bones caused by rheumatoid arthritis, or "bone erosion" in the X-rays, which is a missing portion of the bone.

But those bone erosions or joint destructions do not appear in the very early stage, even though the patients are suffering from rheumatoid arthritis.

After the onset of the disease, the X-ray often comes out normal for a while.

As seen here, it is only after the disease progresses to a certain degree that it appears in X-rays.

Rheumatoid factor and anti-CCP antibodies are used for detecting immune abnormalities which help to determine if the patient has rheumatoid arthritis.

However, the positivity of rheumatoid factor and anti-CCP are 80%, which means 20% of patients with RA come out negative for those tests.

- So a positive or a negative result does not confirm diagnosis?
- That's right.

The tests are very useful, but it is not conclusive.

This is why a comprehensive diagnosis is important.

What is being done to solve such problems?

Now, let's find out about one of the latest testing methods that may lead to the early detection of RA.

The method used for the early detection of rheumatoid arthritis is joint ultrasonography.

With joint ultrasonography, inflammation of the synovial membrane caused by rheumatoid arthritis can be observed directly.

The image of the healthy joint does not show any particular color, but the RA patient has areas that swell and appear red.

This is evidence of synovium proliferation and inflammation.

Furthermore, bone erosion, which indicates bone damage caused by RA, can also be identified by this examination.

Joint ultrasonography sounds easy and quick.

Yes.

Ultrasound is harmless and can be performed even on people with artificial joints or other metal objects in the body.

Today we learned about what signs to look out for and also the different testing methods.

I want to watch out for any early symptoms.

Yes.

If you suspect that you have rheumatoid arthritis, we recommend that you see a rheumatologist as soon as possible.

Those are all really good points.

Dr. Kaneko, thank you so much for being on our show.

It was a pleasure, thank you for having me.