It happens every day, all over the country. People with joint problems make appointments with their doctors, wanting a quick answer. They want to know what’s wrong and how it can be fixed. The signs and symptoms that lead people to the exam room are typically joint pain, swelling or stiffness. Sometimes unexplained fatigue and a lingering sense of illness are problems, too.
Primary care providers are usually the first stop for joint problems. Someone who’s been searching for answers for a while may see to a rheumatologist, a doctor who specializes in diagnosing and treating arthritis and rheumatic conditions, or an orthopaedic specialist, or joint surgeon. All of them are going to approach joint problems in a similar fashion, but with differences in depth and breadth of examination and testing. A generalist will likely do a top-level exam and some basic tests looking for some of the more common types of arthritis. A rheumatologist will do a comprehensive and thorough assessment; an orthopaedist will evaluate the physical, or mechanical, cause of joint pain and determine the potential for a surgical solution.
Here is an overview of the ways in which health care providers, on their own or as part of a team, evaluate joint problems and diagnose or eliminate arthritis.
Medical & Family History
The evaluation should start with questions and answers.
· Symptoms. When did they start?; what’s the level of pain?; when does the stiffness occur, is it after activity or rest?; and how long does it last?; do symptoms come and go, or have they stayed the same over time?; and what, if anything, relieves the pain?
· Current, Recent and Past Health. Have you been sick recently?; have you traveled out of the country, to the Rocky Mountains, New Mexico or spent time in wooded areas, particularly in the Northeast?; do you have an autoimmune condition?; have you injured the joint or joints recently or long ago?; do you play contact sports or ones that require quick turns and pivots (like soccer or basketball)?; do you work in a job that requires long hours of standing or sitting, frequent kneeling or repetitive motion?; do you have other chronic diseases, such as high blood pressure or diabetes?; and what medications – both over-the-counter and prescription – and supplements, herbs and vitamins are you taking?
· Health Habits. Do you smoke?; are you at a healthy weight?; do you exercise regularly?; what do you do and how often?; do you eat healthful foods or too much processed, fatty or sugary foods?; do you get enough sleep?; do you have lots of stress?; and do you have any mental health issues, like depression or anxiety?
· Family History. Does anyone in the family – parents, siblings, grandparents or even aunts or uncles have any type of arthritis or rheumatic disease; and how about an autoimmune condition?
Physical Exam
A joint evaluation is hands-on work. Doctors look to see which joints have visible signs of joint swelling, stiffness or redness. The exam is detailed. Knowing the fingers are affected is a little helpful, but seeing which finger joints -- the knuckles, middle joints or tip joints – is very helpful. If more than one joint is involved, there will be a joint count, and check for whether the pattern is symmetrical, that is, whether the same joint is affected on both sides of the body (for example, both wrists). The doctor will feel the joint for warmth, swelling and fluid. The doctor will move the joints back and forth to see range of motion, and will and gently prod to see if there are tender areas near or far from the joint. Then there are the usual exam steps -- a temperature reading, a check for swollen glands, a look into the eyes and down the throat, as well as a reflex check, too.
Imaging Tests
Depending on the findings so far, your doctor may order lab and/or imaging tests.
· Lab Tests. Blood may be drawn to check for levels of inflammation, presence of antibodies, and status of general systems (complete blood count, liver and kidney function, etc.). The doctor may use a needle to draw fluid from the joint for analysis. In some cases, a genetic test may be ordered.
· Imaging Tests. X-rays are the most frequently used means of visualizing the joint, but sometimes ultrasound and MRI are used. The image will be read for structural changes in the joint, signs of joint erosions, cartilage loss, soft tissue tears, inflammation, location and amount of fluid, and presence of loose tissue fragments.
Making an arthritis diagnosis can sometimes be relatively straightforward -- but not always. The diagnostic process includes eliminating problems other than arthritis. But if the problem seems to be arthritis, then which type of arthritis is it? There are more than 100 types of arthritis and related conditions. Osteoarthritis is by far the most common type, and is often the first consideration, but many other types are relatively rare. Symptoms may come and go over time. And some types of arthritis don’t reveal their full range of effects at once. Sometimes a key feature that would confirm a diagnosis doesn’t show up for years. Oddly enough, one type of arthritis can be mistaken for another, and people may have more than one type.
Even if the specific diagnosis isn’t clear, but signs point to an inflammatory type of arthritis, doctors may go ahead and start treatment to bring down high levels of inflammation. Taking corticosteroids or disease-modifying anti-rheumatic drugs can help avoid the permanent joint damage that can occur in active, uncontrolled disease. Waiting to treat inflammatory arthritis is highly risky. That’s why rheumatologists say early diagnosis and aggressive treatment are the keys to preventing visible joint changes, chronic pain, loss of mobility and decreased function.
Whether or not treatment has begun, your doctor will likely advise at-home measures, such as heat and cold to soothe pain, resting the joint regularly and protecting it from strain and overuse.