DIAGNOSING ARTHRITIS

lt’s important to distinguish everyday aches and pains from the onset of arthritis because early detection can prevent permanent damage. Warning signs include:

— persistent pain and stiffness upon awakening or at the end of the day
— pain, tenderness, or swelling in one or more joints
— inability to move a joint normally
— recurrent or persistent pain and stiffness in joints
— symptoms such as these that last for more than six weeks.

Making an accurate arthritis diagnosis, however, is not always easy. Prompt medical attention may prevent irreversible damage, but it may take a couple of weeks to several months to achieve a detailed diagnosis. If your personal physician is unable to arrive at an accurate diagnosis, you should be referred to a rheumatologist (a physician who specializes in the diagnosis and treatment of all forms of arthritis).

ln addifion to physical examinations, physicians use tests to assist in the diagnosis of arthritis, including X rays, blood tests, joint fluid analysis, and examination of small samples of muscle or joint tissue. X rays can show revealing changes in the joints and blood tests can ' indicate whether a complex protein called rheumatoid factor or elevated levels of uric acid are circulating in your bloodstream. Joint aspiration and tissue biopsies are not the most comfortable tests you’ll ever find in a doctor’s office, but they can be critically important in establishing the definitive diagnosis.

There may soon be additional means of diagnosing arthritis. We’ve discussed the growing role of magnetic resonance imaging (MRI) in the diagnosis of knee problems. Eventually MRI may replace arthrography and arthroscopy, which are also occasionally used in the diagnosis of OA and RA. MRI may offer a great advantage in the diagnosis of arthritis patients who report pain but do not yet have clinically recognizable signs of disease. This is a particularly frustrating phenomenon early in the course of the disease. Just when medical intervention may be most successful, arthritis is most difficult to diagnose.

Another new technology may soon let doctors hear your body talk. By tuning in to the vibrations a joint makes when it moves, by listening for that nearly inaudible crackle like crumpled plastic that reveals early arthritis, doctors may be able to detect arthritis in a noninvasive manner even before some of the current invasive approaches can be successfully utilized. Many of us are unnerved by the snap, crackle, pop of our joints, but that’s not really related to arthritic changes. To the human ear the sounds of arthritis really are the sounds of silence. It takes an inexpensive ($200) device called a rectifying-demodulating phonopneumograph (mercifully shortened to RDP) to listen in on your joint complaints. The microphone picks up inaudible sounds and produces a graph that displays a normal knee with both sharp peaks and smooth curves of sound or an arthritic knee, which graphs out with only sharp multipointed peaks.

While we still have no known cure for the major rheumatic diseases, the significance of what we have learned is substantial. If arthritis is not inevitable or a necessary consequence of activity, then there must be ways to interrupt the process, manage the disease, and possibly reverse it. We’ll take up the rest of this story later in our section on reliefand rehabilitation.