Aging, Systemic Disease and Oral Health: Implications for Women Worldwide (Part II)
Diagnosis

Diagnosing RA is challenging even during its early stages due to the variety of symptoms; many appearing similar to other arthritic disorders characterized with intense pain. A rheumatologist, specializing in diseases of connective tissue and joints typically is the one to diagnose and prescribe long-term management approaches.³⁰ A physical examination, discussion of symptoms, x-rays (Figure 6) and a blood test comprise an essential diagnostic work-up.²⁹ X-rays may not clearly identify bone changes in early stages; whereas ultrasound and magnetic resonance imaging (MRI) provides greater sensitivity in detecting early joint damage and erosions.³⁵ Immunological testing determines the presence of a specific antibody, rheumatoid factor (RF), identified in approximately 80% suffering with RA after one year.³⁶ Not all individuals present with an indicator of disease. Some with the RF may never be diagnosed with RA and others with RA may never exhibit the RF.²⁹

RA is a disabling disease with most daily activities impaired. At least 50% of those diagnosed ten years from onset are unable to maintain full time employment. Those diagnosed before age 45 encounter greater disabilities than those diagnosed at 70+.³⁰ The American College of Rheumatology (ACR) collectively defines the following as criteria used in classifying RA and states a minimum of four are necessary to be met for classification. They are as follows:

1. Arthritis along with soft-tissue swelling in >3 of 14 joints/or groups of joints for a minimal duration of six weeks.
2. Arthritis in hand joints for a minimal duration of 6 weeks.
3. Specific places with subcutaneous nodules.
4. Morning stiffness of six weeks and > one hour on most mornings.
5. Six week duration of symmetrical arthritis.
6. Joint erosion identified radiographically.
7. RH factor level > 95%.

According to the ACR, criteria were designed to categorize research and further establish epidemiological associations for those with RA.³⁷