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Elevated ferritin levels can reveal hemochromatosis , a mimic of RA, or be a sign of Still's disease , a seronegative, usually juvenile, variant of rheumatoid arthritis. These new classification criteria overruled the "old" ACR criteria of and are adapted for early RA diagnosis.
In the "new" criteria serology and autoimmune diagnostics carries major weight, as ACPA detection is appropriate to diagnose the disease in an early state, before joints destructions occur.
Destruction of the joints viewed in radiological images was a significant point of the ACR criteria from In clinical practice, the following criteria apply:[ citation needed ] two or more swollen joints morning stiffness lasting more than one hour for at least six weeks the detection of rheumatoid factors or autoantibodies against ACPA such as autoantibodies to mutated citrullinated vimentin can confirm the suspicion of RA.
A negative autoantibody result does not exclude a diagnosis of RA. Differential diagnoses[ edit ] Several other medical conditions can resemble RA, and need to be distinguished from it at the time of diagnosis:  Crystal induced arthritis gout , and pseudogout — usually involves particular joints knee, MTP1, heels and can be distinguished with an aspiration of joint fluid if in doubt.
Redness, asymmetric distribution of affected joints, pain occurs at night and the starting pain is less than an hour with gout. Osteoarthritis — distinguished with X-rays of the affected joints and blood tests, older age, starting pain less than an hour, asymmetric distribution of affected joints and pain worsens when using joint for longer periods. Systemic lupus erythematosus SLE — distinguished by specific clinical symptoms and blood tests antibodies against double-stranded DNA One of the several types of psoriatic arthritis resembles RA — nail changes and skin symptoms distinguish between them Lyme disease causes erosive arthritis and may closely resemble RA — it may be distinguished by blood test in endemic areas Reactive arthritis — asymmetrically involves heel, sacroiliac joints and large joints of the leg.
It is usually associated with urethritis , conjunctivitis , iritis , painless buccal ulcers, and keratoderma blennorrhagica. Axial spondyloarthritis including ankylosing spondylitis — this involves the spine, although an RA-like symmetrical small-joint polyarthritis may occur in the context of this condition. Hepatitis C — RA-like symmetrical small-joint polyarthritis may occur in the context of this condition.
Hepatitis C may also induce rheumatoid factor auto-antibodies. Rarer causes which usually behave differently but may cause joint pains:  Sarcoidosis , amyloidosis, and Whipple's disease can also resemble RA.
Hemochromatosis may cause hand joint arthritis. Acute rheumatic fever can be differentiated by a migratory pattern of joint involvement and evidence of antecedent streptococcal infection.
Disease of the connective tissue, joints, and bones. Disease of the skin. Disease of the nervous system. Principales of critical care medicine. Principales of oncological and palliative care.
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