Indications directory

Clinical presentation:

                                   ACR-criteria 1-4 must be present for a minimum of 6 weeks. A rheumatoid arthritis is secured by 4 criteria.

                                   ACR-criteria (1988):

1. Morning stiffness for a duration of a minimum of 1 hour until reaching maximal possible improvement
2. Soft tissue swelling of a minimum of 3 joints (proximal interphalangeal-, metacarpophalangeal-, carpal-, elbow-, knee-, upper ankle-, MTP-joints)
3. Swelling of the proximal interphalangeal-, metacarpophalangeal- or carpal joints
4. Symmetrical swelling of the joints under 2., bilateral participation of PIP-, MCP-, carpal joints (3.), without absolute symmetry is acceptable
5. Rheumatoid node: Subcutaneous nodules over bony prominences at the extensor sides or close to the joint
6. Positive rheumatoid factor in the serum
7. Typical X-ray findings with a minimum of joint-near osteoporosis or erosions of the joints in the hand, especially of the affected joints, ACR-criteria = classification criteria

General laboratory tests:

ESR, CRP, rheumatoid factor, anti-CCP, full blood count, GOT, GPT, gamma-GT, creatinine, urine status and sediment.

Please note: The rheumatoid factor is often still negative at onset of illness. Only after a duration of illness of over a year, the RF will be positive with a prevalence of 70-80 %. Anti-CCP is positive earlier.

Special evaluations/Differential diagnosis:

ANA (10-60 %), ENA, cardiolipin antibodies, beta-2-glycoprotein-I-antibodies, complement C3 and C4, immune complexes, cryoglobulines, HLA-DR4 (RR: 10,2; 3ml EDTA blood), synovial analysis

Special forms of rheumatoid arthritis:

Felty’s syndrome: Leukocytopenia, anemia, RF (90 %), ANA (80-100 %),

Still’s syndrome (in children and adolescents): Fever, leukocytosis, skin exanthema, hepato- or splenomegaly