Evolution and clinical manifestations
Although a specific cause of origin is not known, we know very well the alterations of the body tissues associated with rheumatoid arthritis. This disease begins with an inflammation of the synovial membrane (a sort of lining inside the joints) associated with the deposition of proteins (fibrin). The inflammatory process of the synovium, which soon will also extend to tendons, bags and ligaments, produces a lot of liquid that is poured into the joint. Under normal conditions, this fluid, called synovial fluid, is important to ensure the nourishment of the articular cartilage and protect the joint from impacts. When it is excessive, it causes widespread joint swelling; characteristic is that of the fingers, which take on the typical spindle shape.
The persistence of inflammation leads to a growth of inflammatory tissue towards the center of the joint, which extends slowly also to the surrounding tendons and ligaments, which appear thickened and hyperemic. The degenerative process also affects the articular cartilage, which is deeply eroded with involvement of the underlying bone, with cyst formation. With the passage of time the phlogosis becomes chronic, with passage from inflammatory tissue to fibrous or scar tissue. The resulting thickening of the intra-articular tissues, associated with cartilage degeneration and swelling, significantly reduces the mobility of the joint.
Diagnosis
The diagnosis of rheumatoid arthritis begins with an accurate medical history, followed by a physical examination. By listening to the patient's complaints or by asking questions himself, the specialist looks for useful elements to make his own diagnosis. This preliminary visit, associated with some simple blood tests, is normally sufficient to diagnose rheumatoid arthritis.
As for blood tests, we will search for all those parameters involved in the genesis of the inflammatory process. The sedimentation coefficient must therefore be evaluated, which is tendentially high in subjects suffering from rheumatoid arthritis. Other blood tests of great interest are aimed at the search for particular antibodies, such as the so-called rheumatoid factor (RF) and the anti-cyclic citrullinated peptide (anti-CCP). These antibodies are commonly present in the blood of people affected by this particular arthritic form, even if some subjects escape this correlation. It has also been shown that high levels of rheumatoid factor and anti-CCP antibodies during the early stages of the disease seem to be associated with a greater risk of severe joint damage. Finally, the same elements are found in the blood of people affected by chronic infections, such as tuberculosis, or other immune-based rheumatoid forms, such as lupus or Sjogren's syndrome.
In cases of rheumatoid arthritis, elevated ferritin levels associated with anemia are commonly found.
In other cases the doctor can take a small sample of joint fluid, on which tests will be performed to rule out the presence of other pathologies.
Radiological examinations are performed at regular time intervals to monitor the evolution of joint damage.
