Diagnosis

Seven criteria must be met to diagnose RA appropriately:1

1. Morning joint stiffness lasting more than 1 hour before disappearing

2. Involvement of three or more joint areas

3. Arthritis of hand joints

4. Symmetric joint involvement

5. Presence of rheumatoid nodules

6. Elevated rheumatoid factor

7. Radiographic changes

A patient may be diagnosed with RA if four or more of these are present. Criteria 1 through 4 must be present for at least 6 weeks. Criteria 2 through 5 must be observed by a clinician.

Table 57-2 Comparison of RA and Osteoarthritis

Characteristic

RA

Osteoarthritis

Gender prevalence

3:1

1:1

(wpmenimen)

Peak age of onset

3S-50

Greater than bS

Risk factor of

No

Yes

obesiiy

Morning stiffness

Usually 60 minutes

Usually loss than

or longer

30 minutes

nvoived joint

Symmetric

Symmetric or

distribution

asymmetric

Presence of

Local and systemic

None or mild,

nflammation

local

ESR

Elevated

Normal

Synovial fluid

Leukocytosis,

Mild leukocytosis

slightly cloudy

Systemic

Yes

No

manifestations

l~SRrerythrocytesedimenlarion rjle hrom Kef. 6

FIGURE 57-1. Patterns of joint involvement in rheumatoid arthritis and osteoarthritis. (From DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy, 7th ed. New York: McGraw-Hill; 2008, Fig. 92-3, p. 1507, with permission.)
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