Can An X Ray Detect Rheumatoid Arthritis

Earl Hamilton
• Saturday, 31 October, 2020
• 7 min read

Today’s more modern technology provides advanced imaging techniques like MRIs and ultrasounds, which allow doctors to find early signs of RA more easily. All types of imaging tests are a critical component of diagnosing RA and monitoring the patient’s disease as it develops over time.

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Imaging tests provide doctors with a literal picture of the patient’s progression so that they can pursue appropriate treatment options. These tests essentially look inside the patient’s body so that doctors and other specialists may assess the joint damage as well as detect and interpret specific abnormalities.

Depending on what they find, doctors can use imaging test results to help reach a diagnosis of RA. RA imaging tests look for signs of bone erosion, inflammation and swelling, tissue damage and overall joint deterioration.

Imaging tests identify this early on so that targeted treatment can begin and attempt to prevent further damage to the joint. If imaging tests do not find any specific or conclusive signs of bone deterioration, it doesn’t entirely rule out a RA diagnosis.

Treatment is far more effective in reducing pain, stiffness, swelling and bone erosion when started in the early stages of the disease. Doctors may use one or a combination of all of these imaging tests to help reach a RA diagnosis and continue to monitor progression.

X -rays are radiographic imaging tests that allow doctors to find locations in their patients where bone erosion is occurring at the joints. Though x -rays are a preferred method of imaging test, they aren’t great at detecting the earliest signs of RA.

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Whereas X -rays mostly just look at bones, MRIs detect abnormalities in the soft tissues like muscles, tendons and joint capsules. MRIs are able to detect these areas with greater fluid build-up, which helps in predicting future bone erosion.

Like MRIs, ultrasounds are better at detecting early signs of erosion caused by RA compared to x -rays. Ultrasound results can reveal areas of joint inflammation, which can help support a RA diagnosis.

Tests are helpful tools in reaching a diagnosis and providing a clear medical picture of the patient’s present condition. However, it is difficult for doctors to deliver a firm prognosis for RA as the disease manifests itself uniquely in each patient.

X -rays can reveal certain signs of inflammation and damage (joint erosion) that are indicative of RA. Typically, your doctor will take x -rays of joint in your hands, wrists, and feet.

Newer MRI scanners do not require complete insertion into the scanning tube. You will be asked to remain motionless for a period of time, lasting anywhere from several seconds to several minutes.

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(Source: www.sciencephoto.com)

If you tend to get claustrophobia (intense fear of tight or crowded spaces), tell your physician. If you don’t like enclosed spaces and would prefer not to get sedation, ask your physician if an open-sided MRI scanner is an option.

MRI creates a powerful magnetic field and radio waves to manipulate the position of hydrogen protons within your body. As the protons change position, they give off signals that can be picked up by the MRI scanner.

Ultrasonography (ultrasound, for short) provides another form for imaging and measuring joint involvement in RA. In truth, there are several factors that go into the proper diagnosis of true arthritis ““ the presence of joint tenderness, redness of the skin around the joint, inflammation of the joint capsules, the presence of inflammatory markers in the blood such as elevated CRP, used rate, ANA, etc.

What I would like to emphasize, however, is that being diagnosed with arthritis is not only frequently an inaccurate label foisted upon you by your clinician, but even the presence of true, clinical arthritis does not mean you will have pain or immobility for the rest of your life. In my years in medicine, I have seen people with X -rays that show NO EVIDENCE of joint damage and their blood tests show virtually no evidence of inflammatory disease, but their clinical symptoms are quintessentially those of arthralgias, immobility, even body-wide pain.

I have seen other patients with knee X -rays showing joint damage so severe that they shouldn't be able to walk, but instead continue to play sports or dance without any significant pain or impairment. For those with no evidence of joint injury or inflammatory disease, a proper assessment by a doctor truly experienced in the diagnosis of the other causes of joint destabilization and pain may lead to a better understanding of what ails you ““ leading to proper treatment.

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(Doctor of Osteopathic Medicine) ““ which includes all the above tests as well as a full hands-on functional assessment of the neurologic, muscular, and skeletal systems ““ may lead to diagnoses that are not found by other means. In addition, MRI detects areas of increased fluid (edema) in bone marrow that is a predictor for the development of bony erosion.

“Ultrasound is a very important imaging tool for RA because it is readily available in the office, and you can scan many joints,” says lead researcher Flavia Machado, MD, of the Universidade Federal of São Paulo. “You can see the same bone erosion and synovial lining changes in other rheumatic diseases, such as lupus and psoriasis arthritis (and also in asymptomatic volunteers), so the clinical history and physical examination is still important, with careful evaluation of the pattern of joint involvement and some blood tests to make the diagnosis,” says Dr. Machado.

In recent years, there has been increasing emphasis on using objective scores to monitor disease activity and decide when and if you need a change in treatment to bring RA under control. “If your joints are tender and swollen and levels of inflammatory markers are elevated, your doctor doesn’t need modern imaging to know you aren’t doing well, and it’s time to adjust your treatment,” says Dr. Jonathan.

For tracking joint damage, plain X -rays are still useful if your doctor can examine changes in your films over time, Dr. Jonathan adds. “After several months on a DM ARD or biologic, a patient may be asymptomatic, but you can tell the disease is not under control if you still see a thickened synovial lining with power Doppler,” says Dr. Machado.

There is no single physical exam or lab test to decisively diagnose RA. RA's symptoms often mimic those of other diseases, such as lupus, systemic sclerosis, psoriasis arthritis and polymyalgia rheumatic.

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(Source: www.healthguideinfo.com)

Because of these challenges, experts recommend that a diagnostic evaluation be performed by a rheumatologist or a physician who has extensive experience with hematologic diseases. To help doctors make early diagnoses, the American College of Rheumatology and the European League Against Rheumatism collaborated to create the 2010 RheumatoidArthritis Classification Criteria.

People with rheumatoid arthritis usually have several joints with active synovitis symptoms lasting 6 or more weeks. Synovitis is inflammation of a joint’s synovial tissue, and its symptoms can include swelling, redness, warmth, pain, and stiffness, particularly after a long period of rest.

However, there are several blood tests that may be ordered to detect changes in the body that are indicative of rheumatoid arthritis. Commonly used blood tests measure the presence of rheumatoid factor (RF), anti-cyclic citrullinated peptide (called APA or anti-CCP), and inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

A doctor may order imaging if the patient’s clinical evaluation and lab tests did not provide enough information to diagnose or rule out rheumatoid arthritis. This imaging technology is used to detect inflammation of the delicate synovial tissue that encapsulates some joints and tendons.

Ultrasound can also detect tenosynovitis in the finger, which some researchers believe to be an early sign of RA. Ultrasound is performed using either traditional “b-mode” (gray scale) or power Doppler.

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While less common and more expensive, power Doppler can detect the flow of blood, allowing a physician to see if the synovial inflammation is active. In addition to being a helpful diagnostic tool, ultrasound can be used to monitor a patient’s response to treatments (though it is rarely used in clinical practice).

X -rays can help detect bone damage (erosion) that occurs as a result of long-standing rheumatoid arthritis. Like ultrasound, MRI can detect inflammation and other changes in the joint’s soft tissue before bone erosion takes place.

X -rays are used to diagnose osteoarthritis, typically revealing an uneven loss of cartilage and spurring of the underlying bone. Sometimes blood tests and joint aspiration (using a needle to draw a small sample of fluid from the joint for testing) are used to rule out other types of arthritis.

If your doctor suspects infectious arthritis, testing a sample of fluid from the affected joint will usually confirm the diagnosis and guide treatment. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Markka Center for Applied Ethics, Santa Clara University. Easy Exercises for Joint Health Hint: Warming up first is crucial.

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(Source: radsource.us)

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