Art and Science of Inflammatory Arthritis Diagnosis


When it comes to making a diagnosis of inflammatory arthritis, how do we get there?

When you really look up what are the diagnostic criteria for inflammatory arthritis conditions, including rheumatoid arthritis, it can seem really complicated and convoluted, and not always very straightforward. The reality is that if you can simplify your thinking in a deep and meaningful way, you can take something that seems very complex and make it more straightforward, understandable, and meaningful. And in that way as a professional, as a physician, you can really make your understanding profound enough where your decision making can become more efficient and straightforward as well.

So in this patient’s case today, she wanted to know, how do you come to a diagnosis of inflammatory arthritis?

In her case, there were a few things that were really key. Number one, she had a story that was on point, namely multiple joints were involved, symptoms that were better with activity and worse first thing in the morning and with rest. Number two, her examination had some subtle findings that were consistent with an inflammatory arthritis diagnosis as well, although not really too overwhelming. But more than anything else, in the end, that combination of story, along with diagnostic musculoskeletal ultrasound, really helped to make her diagnosis.

Musculoskeletal ultrasound, if you are a physician that sees patients that have joint and tendon issues, this is your stethoscope. This is how you really can help confirm your diagnosis, how you can help make your diagnosis. In this patient’s case, she had some subtle effusions in a few joints, and she had one particular tendon in her left wrist that showed some very classic inflammatory findings. That combination, history, some subtle exam findings, and ultrasound, really sealed her diagnosis. So she asked about, is there some value in checking labs, any additional imaging? And there can be in some cases.

And in her case, we’ll check some additional labs, because it helps to not only confirm diagnosis, but it also gives us some sense of prognostic value as well. But really, her diagnosis, and thus, decision making in terms of what needs to be done in her case, are made based on a couple of very straightforward focused questions, some examination findings to help rule out other things and also rule in a diagnosis. And lastly, and possibly most profoundly, is really the ultrasound findings.

That combination can help simplify a diagnosis, help simplify in terms of what needs to be done, and put this patient on the right track to getting the right treatment, to getting better faster, sooner, and longer-term as well.