What is Arthritis test? 

The term arthritis is often used to talk about stiffness, swelling and pain in the joints. It is not a single condition but a group of conditions that can affect anyone at any age, though some types are more common in older people. Arthritis may occur due to multiple reasons, and it could be genetic. 

There are different types of arthritis. These include:

  • Osteoarthritis: Osteoarthritis is the commonest type of arthritis. It is generally seen in women and people over 45 years of age. The knees, back, hips and hands are the most commonly affected parts. If you are overweight, there is a higher chance of being affected by osteoarthritis.
  • Gout: Gout is an inflammatory type of arthritis that occurs due to over accumulation of uric acid (hyperuricemia) in the body. The excess uric acid forms crystals in and around joints, leading to painful swelling and redness in the affected joint along with itching and peeling of skin over the joint. Gout generally affects the big toe but may affect other joints. Pseudogout is a condition that occurs due to deposition of calcium crystals in joints. 
  • Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune inflammatory condition that occurs when your immune system starts attacking and damaging your joints. Normally, your immune system fights infectious microbes and protects you from illnesses. In an autoimmune condition, however, your immune system starts attacking healthy body tissues. This leads to inflammation and wear and tear. Rheumatoid arthritis is more common in women and it generally shows up between the age of 40 and 60 years. 
  • Ankylosing spondylitis: Ankylosing spondylitis causes swelling and pain in the joints of the spine. It is more common in men and generally occurs between the age of 20 and 30 years. 
  • Psoriatic arthritis: Psoriatic arthritis is yet another autoimmune condition that is seen in people who have psoriasis. 
  • Juvenile idiopathic arthritis (JIA): If you have been diagnosed with arthritis before you turn 16, it is known as JIA. This condition is of different types and autoimmune in nature. 

The arthritis profile is performed to diagnose arthritis. It includes the following tests: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-streptolysin O, calcium, phosphorus, rheumatoid factor (RF), uric acid and vitamin D3.

  • ESR: This is a blood test that checks the rate of settling (sedimentation) of red blood cells (RBCs) in a test tube. ESR is higher when the RBCs settle faster. In case of an infection or inflammation in the body, the presence of extra proteins in blood causes the RBCs to settle faster.
  • CRP: This blood test checks for the levels of C-reactive protein in your blood. CRP is a part of the immune system. The levels of this protein increase when you have an infection or inflammation.
  • Antistreptolysin O: This blood test measures the antibodies that are produced against streptolysin O, a chemical that is synthesized by group A streptococcus bacteria. Post streptococcal reactive arthritis is a condition that may occur in people after a streptococcal infection
  • Calcium: This blood test is used to detect the amount of calcium in body. It helps in diagnosing and monitoring bone diseases.
  • Phosphorus: This blood test checks for the levels of phosphate in the blood, which contains phosphorus. Phosphorus helps in building and repairing the bones and teeth. Phosphate levels fall as calcium levels rise in the body. The parathyroid hormone in the body moderates the levels of phosphate.
  • RF test: The Rheumatoid factors (RF) test is a diagnostic test for rheumatoid arthritis. RF is an antibody that is increased in response to the inflammation in rheumatoid arthritis. RF does not cause rheumatoid arthritis, but it is elevated due to the inflammation.
  • Uric acid: This is a blood test to check the amount of uric acid. This painful inflammation is known as gout.
  • Vitamin D3: The vitamin D blood test detects the levels of vitamin D in the blood. Vitamin D is found in two forms: vitamin D2 and vitamin D3. The vitamin D3 is synthesised in the body in the presence of sunlight and obtained from some food items like eggs, salmon and tuna. Both the forms of vitamin D in the body is converted to 25-hydroxyvitamin D. A deficiency can indicate disorders in the bone.
  1. Why is Arthritis test performed?
  2. How do you prepare for an Arthritis test?
  3. How is Arthritis test performed?
  4. Arthritis test results and normal range

Your doctor may order the arthritis profile if you show symptoms of arthritis. Some of the common symptoms are: 

  • Stiffness in at least one joint
  • Trouble moving at least one joint normally
  • Swelling in at least one joint
  • Continuous or recurrent pain in one or more joints
  • Redness and warmth in at least one joint

Depending on the type of arthritis, your symptoms may vary. 

The following are the symptoms of Rheumatoid arthritis:

  • Joint pain
  • Swelling over the joints
  • Pain that is worse with joint movement
  • Trouble doing daily activities, such as tying shoes, opening jars or fastening buttons on shirts
  • Stiffness, especially in the morning
  • Tiredness and lack of energy (fatigue)
  • Occasional fever

Gout may show the following symptoms:

  • A lot of pain
  • Swelling
  • Inflammation
  • Tenderness
  • Shiny skin over the joint that may peel off a little

Osteoarthritis may manifest in the form of:

  • Pain and stiffness in the affected joints
  • Swollen joints
  • Crepitus: cracking or grating sounds on the movement of the affected joints
  • Muscles around the joint may become wasted

Wear a t-shirt or shirt with short sleeves for the test. Inform your doctor if you are taking any drugs including non-prescription drugs, herbs, vitamins, supplements and illegal drugs. 

Aspirin, steroids and nonsteroidal anti-inflammatory drugs can lower the CRP levels. Medicines like lithium, thyroxine, vitamin D, thiazide diuretics and calcium salts affect the results of calcium test. Antacids, laxatives and diuretics (water pills) affect phosphorus test results. Dialysis may also affect your phosphorus levels. Your doctor may either change the course of some of these medicines or ask you to stop taking them for a while before the test.

Uric acid test results are affected by aspirin, caffeine, alcohol, diuretics, cisplatin, levodopa, oestrogen, glucose, mannitol, warfarin, corticosteroids, etc Some additional preparations that are needed before the other tests in this profile are as follows:

  • You may have to fast overnight or a few hours before the test. 
  • Some conditions that can increase ESR are pregnancy, menstruation or having a fatty meal just before the test. Inform your doctor about these before the test.
  • Smoking, diabetes and lack of exercise can elevate CRP.
  • Consuming excessive quantities of milk and dairy products may raise calcium levels in the body. Foods like cheese, fish, chocolate, beer and cola may modify phosphorus levels in the body. Vigorous exercise and certain foods that contain large amounts of purines like mushrooms, dried peas and beans may also affect uric acid levels. Therefore, your doctor may inform you to stop consuming these foods before the test.

All the tests in the arthritis profile are performed on a blood sample. Your doctor or a lab-technician will insert a sterile needle into a vein in your arm to draw the required amount of blood. 

You may feel a pricking pain as the needle goes in. However, apart from that, blood tests are completely safe. Rarely an infection occurs at the needle insertion site.

If you feel dizzy or uneasy during or after the procedure please inform your doctor.

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Normal results:

The normal values are as follows:

  • ESR:

    • 0-10 millimetres per hour (mm/h) in children
    • 0-15 mm/h in men younger than 50 years of age
    • 0-20 mm/h in men older than 50 years of age
    • 0-20 mm/h in women younger than 50 years of age
    • 0-30 mm/h in women older than 50 years of age
  • CRP:
    • under 10 milligrams per litre (mg/L)
  • Anti-streptolysin O:
    • <5 years: 0-99 international units per millilitre (IU/mL)
    • 5-15 years: 0-249 IU/mL
    • Adult: 0-199 IU/mL
  • Calcium:
    • 8.5-10.2 milligrams per decilitre (mg/dL)
  • Phosphorus:
    • 2.7-4.6 mg/dL
  • RF:
    • Values lower than 60 units per millilitre (U/mL)
  • Uric acid:
    • 3.5-7.2 mg/dL
  • Vitamin D:
    • 30-60 nanograms per millilitre (ng/mL)

Abnormal results:

If the ESR and CRP values are too high, it is an indication of inflammation in the body.

Elevated antistreptolysin O levels could indicate acute rheumatic fever as the values are found to be high in more than 80% of the people with rheumatic fever.

Elevated uric acid can indicate gout.

If you have elevated RF, it is an indication of rheumatoid arthritis.

Elevated phosphate level and decreased calcium level may be an indication of rheumatoid arthritis.

If your vitamin D3 levels are too low, it indicates rheumatoid arthritis.

Along with these, other tests such as x-ray, urine test and skin biopsy may be performed.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Arthritis Diagnosis
  2. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017; Blood Test: Erythrocyte Sedimentation Rate (ESR)
  3. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Adult and Children's Health Encyclopedia
  4. UCLA health [Internet]. University of California. Oakland. California. US; Calcium Test
  5. Michigan Medicine: University of Michigan [internet]. US; Phosphate in Blood
  6. Centers for Disease Control and Prevention [internet]. Atlanta (GA): US Department of Health and Human Services; CDC’s Second Nutrition Report Vitamin D deficiency closely related to race/ethnicity
  7. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms
  8. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2018. Vitamin D Deficiency
  9. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests
  10. National Institute of Health. Office of Dietary Supplements [internet]: Bethesda (MA), US. US Department of Health and Human Services Vitamin D
  11. Cedars Sinai [Internet]: Cedars Sinai Medical Center. Los Angeles. US; Arthritis
  12. Benioff Children's Hospital [internet]. University of California. San Francisco. US; Uric Acid
  13. National Health Service [internet]. UK; Blood Tests
  14. Poddar A, et al. Serum alkaline phosphatase activity & serum calcium levels: an assessment tool for disease activity in rheumatoid arthritis . Indian J Basic Appl Med Res; September 2016;5(4):132-134.
  15. Kostoglou-Athanassiou I, et al. Vitamin D and rheumatoid arthritis. Ther Adv Endocrinol Metab. 2012 Dec;3(6):181-187. PMID: 23323190.
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