This condition requires different criteria to establish the diagnosis.
Dr. Paloma Alejandro, rheumatologist at Soto-Raíces Mindful Rheumatix & Medical Research Group. Photo: Archive of the Journal of Medicine and Public Health. Fabiola Plaza.
“There are 30% of patients with rheumatoid arthritis who do not show antibodies in the blood,” said Dr. Paloma Alejandro, a rheumatologist at the Soto-Raíces Mindful Rheumatix & Medical Research Group, who added that physical assessment and follow-up the patient’s complaints have to be tracked.RELATED
An MRI, for example, or other imaging studies help in patients whose diagnosis is not defined, they require more in-depth examinations to see tissue damage. “You should think about practicing effective medicine, without patients having to spend money unnecessarily,” the expert reflects.
For his part, Dr. Oscar Soto Raíces, director of the Soto-Raíces Mindful Rheumatix & Medical Research Group, added that the diagnosis requires a physical examination that counts how many joints could be affected.
“Sometimes a patient is received with a possible diagnosis, but the most important thing is clinical. In these criteria there are no images, they are necessary, but there are other studies that are also used to establish the diagnosis,” he said.
“If we like to be academic and follow the criteria of the academy, because this involves a number of things, such as counting how many joints are involved and depending on the number of joints, a number is assigned on the scale of the finding. Another part is the test of serology, where some criteria are also taken,” he said.
In this sense, he specified that a patient who has this type of manifestations does not always have rheumatoid arthritis, because in the middle of the classification of pain and swelling it must be present between 5 and 6 weeks in a row.
Regarding this process, Dr. Soto stressed that in the case of rheumatoid arthritis, it usually affects small joints, which is why he indicated the importance of taking this into account for timely diagnosis.
As the assessment progresses, according to Dr. Soto, the images of the patient and his affected joints are a complement, but they are to be part of the visual of the damage caused by the disease, but they cannot by themselves decide on a diagnosis. total.
“In a sonogram, what we rheumatologists look for are two essential aspects: Thickening of the synovium or a positive Doppler signal, that is, active inflammation,” said Dr. Alejandro.
Regarding nuclear studies, the two specialists agreed that this is not even approved by the Academy of Rheumatologists of the United States, therefore, it is not the process by which rheumatoid arthritis can be diagnosed.
“In short, we do not recommend the use of this process to discern arthritis, because what we see in this study does not reveal whether the patient has arthritis. It is not the right study to evaluate these patients,” Soto Raíces said.
Regarding this, Dr. Paloma Alejandro indicated that it is suitable for other conditions, but not for the different types of arthritis that are known.
In conclusion, specialists recommend that primary care physicians use the so-called emaray study as a diagnostic test, which consists of imaging assessment of rheumatoid arthritis.
“We have to make effective medicine and put ourselves in the patient’s shoes, not make them spend time and money on unnecessary tests. Cost-effective medicine,” concluded Dr. Paloma Alejandro.
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