An overactive or malfunctioning immune system drives inflammatory arthritis. There are many different types of inflammatory arthritis, including seropositive and seronegative arthritis. So how do you know you have an inflammatory arthritis, and what should you look for?
Types of inflammatory arthritis
Inflammatory arthritis encompasses various diseases affecting the upper and lower limbs and spine joints. The three most common types are rheumatoid arthritis, psoriatic arthritis, and gout. However, other types include reactive arthritis, seronegative arthritis, and inflammatory arthritis.
Generally, chronic inflammatory arthritis can affect only one joint, such as gout, or multiple joints, such as rheumatoid arthritis.
Diagnosis of inflammatory arthritis
Overall, the diagnosis of autoimmune arthritis relies on the presentation of joint pain combined with blood tests and imaging.
Clinically, people report joint pain and swelling. Often, pain is worse in the morning and better with exercise. Also, pain at night is typical. Generally, the location of joint pain and swelling indicates the type of inflammatory arthritis. For example, rheumatoid arthritis usually affects the hands and feet on both sides, while psoriatic arthropathy and seronegative arthritis mainly affect the spine and sacroiliac joints.
Blood tests can help pinpoint a diagnosis. Doctors generally perform a rheumatoid panel test. Firstly, inflammatory markers such as ESR and CRP are often elevated, but don’t give us a specific diagnosis. However, serologic tests are a little more helpful. For example, rheumatoid factor and anti-CCP are raised in rheumatoid arthritis and other diseases such as lupus. The anti-CCP test is a little more specific to rheumatoid arthritis. A positive rheumatoid factor and anti-CCP is ususally termed seropositive. These markers are negative in psoriatic arthropathy, so we name this disease seronegative. Secondly, genetic tests such as HLA-B27 are positive in seronegative arthritis. Finally, a uric acid test is performed to confirm gout.
Imaging can support the diagnosis. X-rays may show signs of joint damage, but ultrasound or MRI is more sensitive to early joint inflammation and damage.
Sometimes, taking fluid from a swollen joint and testing it for inflammatory cells assists in diagnosing inflammatory arthritis.
Other common questions related to inflammatory arthritis:
What is dactylitis, and is it related to autoimmune arthritis?
Dactylitis, called sausage finger or toe, is common in chronic arthritis. It is often the first sign of autoimmune arthritis and can be present for a few years before other symptoms. We think the swelling is secondary to swelling of the tendons and small joints of the finger or toe.
Generally, if a person presents with a swollen finger or toe, you need to think about a diagnosis of inflammatory arthritis.
Back pain and chronic arthritis: How to differentiate it from mechanical low back pain
Overall, most causes of low back pain are mechanical. Pain comes from damage to the lower back’s discs, joints, and ligaments. However, some cases of low back pain are due to autoimmune arthritis. Back pain from seronegative arthritis generally differs from mechanical back pain. The pain of seronegative arthritis is often worse in the morning and gets better with exercise and medication such as ibuprofen. Also, morning stiffness is common and gets worse as the disease progresses.
Can exercise cause an RA flare-up?
No. Exercise is good for keeping RA well-controlled. However, you should avoid exercise if you have a severe flare.
Does a normal blood test mean you can exclude inflammatory arthritis?
No. While normal inflammatory markers (such as ESR and CSP) and a rheumatoid panel test mean the chances of inflammatory arthritis are lower, they don’t completely exclude a diagnosis. Doctors often combine the clinical findings with blood and imaging to confirm or exclude inflammatory arthritis.
Does inflammatory arthritis show on X-ray?
Yes. X-rays can show evidence of swelling and cartilage damage, such as erosions. However, other tests, such as ultrasound and MRI, are more sensitive at detecting these changes. So, a normal X-ray does not exclude inflammatory arthritis.
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