MODERN APPROACHES TO CLINICAL AND LABORATORY DIAGNOSTICS OF RHEUMATOID ARTHRITIS EARLY ONSET

Abstract

Rheumatoid arthritis (RA) leads not only to a rapid development of disability, but can influence the life of these patients. One-third of patients with rheumatoid arthritis may have signs of disability during the first 3 years of the onset of the disease, while mortality in patients with RA almost two times higher in comparison with the general population. Analysis of recent prospective studies on the progression of the pathological process and predicting of the long-term outcomes in RA clearly indicate the need for clinical evaluation and a comprehensive laboratory and instrumental diagnosis of the disease in the initial manifestations of the most followed by early adequate pathogenetic therapy. The purpose of this survey was to determine modern clinical aspects of diagnosis, the possibility of standard and specialized instrumental examinations in patients with eRA, followed by predicting long-term results. We studied 52 specialized publications on clinical classification and a modern laboratory and diagnostic tests for eRA. This review presents the data of the importance of differentiation of several stages of RA in relation to the time factor. The data on the sensitivity and specificity of the diagnostic classification and clinical criteria of eRA and an algorithm for the identification of the disease were presented. It was shown prognostic value of the main serological markers of RA, and the predictive value for early detection of antibodies to the circulating peptide as a marker of the severity of bone-destructive changes in patients with certain clinical manifestations. Antibodies to the circulating peptide (ACPA) can be detected many years before the onset of RA. Study of anti-citrulline mutated vimentin (anti-MCV) in patients with eRA can be applied as a marker of activity of the process and the subsequent possibility of use for predicting long-term results. This review presents the major diagnostic errors using standard instrumental methods of diagnosis of RA. Describes the diagnostic capabilities of the periarticular soft tissue changes at different stages. Provides information about using US of joints as a methodology for monitoring patients with eRA. The data presents the diagnostic capabilities of magnetic resonance imaging (MRI) in patients with eRA by using different modes of MRI and radiopaque substance with a strong tropism to the synovial membrane. Conclusion: For the purpose of early diagnosis and prognosis of joint erosions appropriate set of laboratory monitoring indicators (ESR, CRP, RF and ACPA anti-MCV) characterize the pathological changes of the articular structure in patients with eRA. The introduction into the routine clinical practice US of joints allows to reach high accuracy of the diagnosis of eRA (before the erosive and destructive changes of bone tissue), which significantly improvement prognosis of the patients. Instrumental examination using MRI (especially in the study of small joints and muscles function T1 fs-fat) is essential for the study of the pathophysiology of objectification of patients with eRA. When conducting MRI in patients with very eRA - is diagnostic and prognostic factor in the rapid progression to erosive and destructive arthritis.

Keywords

• early rheumatoid arthritis
• arthrosonography
• rheumatoid factor
• AT-MCV