Investigations

X-ray

The main X-ray changes are:

• Bony erosions
• Uniform joint space narrowing
• Osteoporosis (thinning) of bone near the affected joint increasing the risk of fracture

X-ray changes are a feature of the more advanced stages of rheumatoid arthritis.

Gross x-ray changes with joint destruction would indicate severe rheumatoid disease.

If lesser but definite x-ray changes are present, then moderate rheumatoid disease is likely.

In mild disease, minimal or no x-ray changes would be expected.

Note:

The degree of x-ray changes, however, does not necessarily equate with the degree of functional restrictions. Other criteria need to be taken into account before determining the extent of functional loss.

Imaging

E.g. Magnetic Resonance Imaging (MRI) scanning which is designed to highlight soft-tissue changes may show:

• Joint effusions (swelling)
• Synovial Hypertrophy (thickening of the joint lining)
• Excess soft tissue around/in the joint

Blood tests

Erythrocyte Sedimentation Rate (ESR) testing is a simple method of measuring the degree of inflammation present.

Plasma Viscosity testing is an alternative method of identifying the degree of inflammation.

Note:

Blood tests to check for inflammation are unhelpful in assessing functional limitations. In the mild stages of rheumatoid arthritis, such tests are likely to show minimal abnormalities.