Imaging study of joint is important to differentiate various kinds of arthritis, and to evaluate the treatment response of the arthritis. Radiograph is the basic and first line imaging study of the joint, but there are overlapped imaging findings between arthritis. The objective of this review is to present a simplified approach to radiographic evaluation of arthritis and to help in making adequate decision to choose a further imaging study among ultrasonography, CT and MRI.
Arthritis ; Arthritis, Rheumatoid ; Joints ; Osteoarthritis ; Spondylitis, Ankylosing

Arthritis is caused by various diseases including rheumatoid arthritis (RA), osteoarthritis, gout and trauma, and joint involvement also occurs in some autoimmune diseases, such as systemic lupus erythematosus and Sjogren's syndrome. Some laboratory tests provide useful information in both diagnosis and prognosis. RF and anti-CCP (cyclic citrullinated peptide) antibody are detected in approximately 70-80% of patients with RA, and often associated with a worse prognosis (e.g., bony erosion and joint deformity). Acute phase reactants, such as erythrocyte sedimentation rate and C-reactive protein, parallel the activity of RA, and their persistent elevation are also associated with a poor prognosis. Crystal examination in synovial fluid is essential to confirm the diagnosis of gout and pseudogout, and the synovial fluid culture is also important in septic arthritis. Anti-nuclear antibody helps to distinguish non-immune arthritis from systemic rheumatic diseases. However, arthritis cannot be diagnosed only with laboratory findings, and physician should consider comprehensive physical examination, clinical findings, and imaging findings as well as laboratory findings. In this topic review, laboratory tests useful for diagnosis of arthritis will be discussed and summarized.
Acute-Phase Proteins ; Arthritis ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Blood Sedimentation ; C-Reactive Protein ; Chondrocalcinosis ; Gout ; Humans ; Joints ; Lupus Erythematosus, Systemic ; Osteoarthritis ; Physical Examination ; Prognosis ; Rheumatic Diseases ; Sjogren's Syndrome ; Synovial Fluid

BACKGROUND: Anti-streptolysin O (ASO) test is usually used to diagnose group A streptococcal infection-related diseases, such as rheumatic fever, reactive arthritis, and various infectious diseases. Despite the recent declining incidence of these diseases, ASO test is still frequently performed as a screening test to diagnose rheumatic diseases. This study re-evaluated the clinical usefulness of ASO test in systemic rheumatic diseases (SRD). METHODS: ASO tests was performed in 825 patients between April and October in 2010. ASO levels were compared between SRD and non-SRD groups of patients. The results of ASO, C-reactive protein (CRP), and rheumatoid factor (RF) were compared among 6 subgroups of SRD: rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Behcet disease, Sjogren's syndrome and others. RESULTS: Positive results in ASO test (>200 IU/mL) were observed in 15.3% (126/825) of the patients tested. None of the ASO positive patients was, however, diagnosed with rheumatic fever or reactive arthritis. There were no statistically significant differences in the mean value (P=0.688) or positive rate (P=0.835) of ASO test between SRD and non-SRD groups. Positive rates of ASO test were also not statistically significant different among six subgroups of SRD patients (all P>0.05), whereas those of CRP and RF tests were significantly different. CONCLUSIONS: The usefulness of ASO test is very low for diagnosing SRD, although it is frequently carried out as a screening test. We suggest that ASO test must be performed selectively when diseases from group A streptococcal infection are suspected.
Arthritis, Reactive ; Arthritis, Rheumatoid ; Behcet Syndrome ; C-Reactive Protein ; Communicable Diseases ; Humans ; Incidence ; Lupus Erythematosus, Systemic ; Mass Screening ; Rheumatic Diseases ; Rheumatic Fever ; Rheumatoid Factor ; Sjogren's Syndrome ; Spondylitis, Ankylosing ; Streptococcal Infections

Recently, gout prevalence is increasing, but in Vietnam the knowledge of gout is not enough. Objectives: (1) Describe clinical X-ray manifestations of bone and joint damage related to chronic gout. (2) Identify suggestive factors to make diagnosis of bone and joint damage related to chronic gout. Methods: The cross-study included 54 patients with chronic gout presented in the Rheumatology Department of Bach Mai Hospital from March-2003 to June-2004. All of them were diagnosed gout according to the criteria of Bennett and Wood-1968 and had tophi nodules. Results: The common findings are polyarthritis (79.6%), lower limbs are involved more common than upper limbs (75-80% of patients had ankle, knee, first metatarsophalangeal joint arthritis) and symmetric arthritis (60% to 70%). All patients had a history of acute gout. 80% of patients had chronic gout presented in X-ray images, including joint space narrowing, erosion, new bone formation at the edge of a gradually expanding tophus. Important factors can be considered of chronic gout were male, middle age, symmetric arthritis of lower limbs, tophi nodules. Conclusions: Suggestive factors and X-ray of bone and join contribute to earlier diagnosis of bone and joint damage in chronic gout.
Gout ; Arthritis ; Juvenile Rheumatoid ; Bone and Bones

Arthritis, Juvenile/complications* ; Humans ; Rheumatoid Nodule

A psoriatic patient may have rheumatoid arthritis, psoriatic arthritis(or both), osteoarthritis or gout. In so far as possible, each of these must be distinguished on clinical grounds with some help from laboratory tests. Psoriatic arthritis is very similar to rheumatoid arthritis but clinically, it is regarded as a unique disease entity, which is found in 1% to 32% of psoriatic individuals. We herein report two cases of psoriatic arthritis that are thought to be distal type and arthritis mutilans on the basis of clinical, serological and radiological features.
Arthritis ; Arthritis, Psoriatic* ; Arthritis, Rheumatoid ; Gout ; Humans ; Osteoarthritis ; Psoriasis

No abstract available.
Arthritis, Juvenile* ; Rheumatoid Factor*

Caplan's syndrome is characterized by multiple small distinct nodules with progressive massive fibrosis and rheumatic arthritis in pneumoconiosis. Although pleural effusions occur infrequently as an extra-articular manifestation, pleuritis can develop without joint involvement in patients with rheumatoid arthritis. We treated an 81-year-old man who had been diagnosed with silicosis with progressive massive fibrosis. He suffered from progressive dyspnea, and chest computed tomography (CT) and echocardiography revealed pleural and pericardial effusions. We speculated that the multiple serositis was related to a rheumatic disorder because the rheumatic factor was elevated in both the pleural and pericardial effusions. After corticosteroid treatment, the serositis improved. We suggest that this case is an atypical pattern of Caplan's syndrome presenting as serositis without arthritis. Rheumatoid serositis should be considered as the cause of pleural or pericardial effusions in patients with pneumoconiosis.
Arthritis ; Arthritis, Rheumatoid ; Caplan Syndrome ; Dyspnea ; Echocardiography ; Fibrosis ; Humans ; Joints ; Pericardial Effusion ; Pericarditis ; Pleural Effusion ; Pleurisy ; Pneumoconiosis ; Rheumatic Fever ; Serositis ; Silicosis ; Thorax

Juvenile idiopathic arthritis (JIA) is a broad spectrum of disease defined by the presence of arthritis of unknown etiology, lasting more than six weeks duration, and occurring in children less than 16 years of age. JIA encompasses several disease categories, each with distinct clinical manifestations, laboratory findings, genetic backgrounds, and pathogenesis. JIA is classified into seven subtypes by the International League of Associations for Rheumatology: systemic, oligoarticular, polyarticular with and without rheumatoid factor, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Diagnosis of the precise subtype is an important requirement for management and research. JIA is a common chronic rheumatic disease in children and is an important cause of acute and chronic disability. Arthritis or arthritis-like symptoms may be present in many other conditions. Therefore, it is important to consider differential diagnoses for JIA that include infections, other connective tissue diseases, and malignancies. Leukemia and septic arthritis are the most important diseases that can be mistaken for JIA. The aim of this review is to provide a summary of the subtypes and differential diagnoses of JIA.
Arthritis ; Arthritis, Infectious ; Arthritis, Juvenile* ; Arthritis, Psoriatic ; Child ; Connective Tissue Diseases ; Diagnosis ; Diagnosis, Differential* ; Genetic Background ; Humans ; Leukemia ; Rheumatic Diseases ; Rheumatoid Factor ; Rheumatology

Since last August, 29 cases of synovial punch biopsy have been carried out with Franklin-Silverman needle which was used in liver biopsy, instead of the specialized needle for the synovium. Authors report the applicable utility of Franklin-Silverman needle for the synovial biopsy, diagnostic value of this procedure and histopathologic findings of the results. The rate of the technical success to abtain synovial tissue was about 76%. Complications after procedure have been very rarely encountered, consisting of mild transient hemarthrosis. In 17 cases, the histopathologic changes was compatible with their clinical findings. In the remainders, we experienced the failures to get synovial tiasue at all in 7 cases and to give the significant synovial changes in 5 successful specimens. Fortunately, the important diagnostic aid was achieved in 3 cases which were conformed early diagnosis of tuberculous arthritis. This needle biopsy was also thought to contribute to rule out the gouty arthritis from other hyperuricemic conditions. But the histologic changes were non specific inflammatory findings in the synovial mambrane of rheumatoid arthritis, osteoarthritis, traumatic and infectious arthritis.
Arthritis ; Arthritis, Gouty ; Arthritis, Infectious ; Arthritis, Rheumatoid ; Biopsy ; Biopsy, Needle ; Early Diagnosis ; Hemarthrosis ; Liver ; Needles ; Osteoarthritis ; Synovial Membrane