Cómo Se Diagnostica La Artritis Reumatoide - Disciplied (2023)

Table of Contents

Cómo se confirma la enfermedad y la remisión de la enfermedad

La artritis reumatoide difiere de la artrosis (artritis de “desgaste”) en que es un trastorno autoinmune en el que el sistema inmunitario ataca por error a sus propias células y tejidos, principalmente a las articulaciones.Como tal, la enfermedad no puede ser diagnosticada solo por los síntomas.En su lugar, se debe usar un examen físico y una combinación de pruebas, que incluyen imágenes y análisis de sangre, para determinar si los resultados cumplen con la definición clínica de la enfermedad.Al hacerlo, no solo se asegura de que el diagnóstico sea correcto, sino que también ayuda a determinar el curso de tratamiento adecuado.

Examen físico

Una de las primeras herramientas de diagnóstico es un examen físico.El objetivo de la evaluación es, en parte, determinar lascaracterísticasdel dolor articular y la inflamación para distinguirlo mejor de otras causas de dolor articular, como laosteoartritis.

Entre las diferencias clave entre laartritis reumatoidey la osteoartritis, las cuales dirigirán algunas de las preguntas que su médico le haga durante su examen:

Artritis ReumatoideOsteoartritis
Áreas afectadasTiende a afectar múltiples articulaciones (poliartritis)Generalmente afecta las manos, los pies, las rodillas y la columna vertebral;a veces involucra solo una articulación (monoartritis)
SimetríaSimétrico, lo que significa que los síntomas articulares en un lado del cuerpo a menudo se reflejarán en el otro lado del cuerpoPuede ser asimétrico (unilateral) o simétrico, especialmente si hay muchas articulaciones involucradas
Fatiga, Malestar, FiebreComún debido a la inflamación sistémica (de todo el cuerpo)No se asocia típicamente con esta enfermedad, ya que no es inflamatoria.
Rigidez matutinaDura más de 30 minutos, a veces más de una hora, pero mejora con la actividad.Breve;menos de 15 minutos

Además de evaluar sus síntomas físicos, el médico revisará su historial familiar.Con frecuencia, la artritis reumatoide puede darse en familias, duplicando el riesgo de la enfermedad si un pariente de segundo grado lo tiene y triplicando su riesgo si un miembro de la familia inmediata está afectado.

Laboratorios y pruebas

Las pruebas de laboratorio se utilizan para dos propósitos principales en el diagnóstico de la artritis reumatoide: para clasificar suestado serológicoy para medir / controlar el nivel de inflamación en su cuerpo.

(Video) ARTRITIS REUMATOIDE. Síntomas, diagnóstico y tratamiento

Estado serológico

El estado serológico (traducido libremente como “estado de la sangre”) se refiere a los identificadores clave de la enfermedad en su sangre.Si estos compuestos se detectan en un análisis de sangre, se dice que usted es seropositivo.Si no se encuentran, se le considera seronegativo.Los resultados seropositivos pueden clasificarse como positivos bajos, positivos moderados o positivos altos / fuertes.

Hay dos pruebas utilizadas para establecer su estado serológico:

  • El factor reumatoide (RF)es un tipo de autoanticuerpo que se encuentra en el 80 por ciento de las personas que viven con la enfermedad.Los autoanticuerpos son proteínas producidas por el cuerpo que atacan las células o productos celulares sanos.Si bien los niveles altos de RF sugieren fuertemente la artritis reumatoide, pueden ocurrir con otras enfermedades autoinmunes como el lupus o trastornos no autoinmunes como el cáncer y las infecciones crónicas.
  • El péptido citrulinado anticíclico(anti-PCC)es otro tipo de autoanticuerpos que se encuentra en la mayoría de las personas con artritis reumatoide.A diferencia de la RF, el resultado positivo de una prueba anti-CCP ocurre casi exclusivamente en personas con artritis reumatoide.Un resultado positivo podría incluso identificar a los miembros de la familia que están en riesgo de contraer la enfermedad.

Cuando ambas pruebas de estado serológico se quedan cortas es en su sensibilidad, que generalmente es inferior al 80 por ciento.Lo que esto significa es que las pruebas, aunque son valiosas para hacer un diagnóstico, son propensas a resultados ambiguos ofalsos negativos.

Es por esta razón que se utilizan como parte del proceso de diagnóstico en lugar de como indicadores únicos.

Marcadores inflamatorios

La inflamaciónes una característica definitoria de la artritis reumatoide.Se realizan pruebas para evaluar el nivel de inflamación observando los marcadores clave en la sangre.Estos marcadores no solo nos ayudan a confirmar el diagnóstico inicial, sino que también se utilizan en el curso de la enfermedad para evaluar nuestra respuesta altratamiento.

Para ello, los médicos utilizarán dos medidas clave:

  • La tasa de sedimentación de eritrocitos (ESR, por sus siglas eninglés)es una prueba que mide la velocidad con que los glóbulos rojos se depositan en el fondo de un tubo largo y vertical, conocido como tubo de Westergren, en una hora.Si hay inflamación, los glóbulos rojos se pegarán y se hundirán más rápidamente.Es una medida no específica de la inflamación, pero una que puede proporcionar información clave valiosa para un diagnóstico.
  • La proteína C reactiva (PCR)es un tipo de proteína producida por el hígado en respuesta a la inflamación.Aunque no es específico, es una medida más directa de la respuesta inflamatoria.

La ESR y la PCR también se pueden usar para diagnosticar laremisión de la artritis, el estado de baja actividad de la enfermedad donde la inflamación está más o menos controlada.

(Video) Artritis o inflamación articular - Qué es, causas, síntomas y tratamiento

Es posible que se requieran otras pruebas si su médico está buscando medir la progresión de la enfermedad (ver a continuación).

Pruebas de imagen

El papel de las pruebas de imagen en la artritis reumatoide es identificar los signos de daño articular, incluida la erosión de los huesos y el cartílago y el estrechamiento de los espacios articulares.También pueden ayudar a rastrear la progresión de la enfermedad y establecer cuándose necesita lacirugía.

Cada prueba puede proporcionar ideas diferentes y específicas:

  • Las radiografíasson especialmente útiles para identificar la erosión ósea y el daño articular.Si bien los rayos X se consideran la principal herramienta de diagnóstico por imágenes para la artritis, no son tan útiles en las primeras etapas de la enfermedad cuando los cambios en el cartílago y lostejidos sinovialesson menos evidentes.
  • Las imágenes de resonancia magnética (IRM)pueden mirar más allá del hueso, detectar cambios en los tejidos blandos e incluso identificar positivamente la inflamación de las articulaciones en la enfermedad temprana.
  • Los ultrasonidostambién son mejores para detectar la erosión articular temprana y pueden revelar áreas específicas de inflamación articular.Esta es una característica valiosa dado que la inflamación a veces puede continuar de manera invisible a pesar de que el ESR y el CRP nos dicen que la persona está en remisión.En tales casos, el tratamiento continúa hasta que se logre una verdadera remisión.

Criterios de clasificacion

En 2010, el Colegio Americano de Reumatología (ACR) actualizó sus criterios de clasificación de larga data para la artritis reumatoide.Las revisiones fueron motivadas, en parte, por los avances en las tecnologías de diagnóstico.Si bien las clasificaciones están destinadas a fines de investigación clínica, sin embargo, se utilizan en la práctica clínica para proporcionar un mayor grado de certeza diagnóstica.

LosCriterios de Clasificación ACR / EULAR de 2010analizan cuatro medidas clínicas diferentes y las clasifican en una escala de 0 a 5. Una puntuación acumulativa de 6 a 10 puede proporcionar un alto grado de confianza de que, de hecho, tiene artritis reumatoide.

Si bien los médicos son los únicos que utilizan este criterio, revisarlo ayuda a establecer más a fondo por qué hacer un diagnóstico de RA no es algo que necesariamente se pueda hacer rápida o fácilmente.

CriteriosValorPuntos
Duración de los síntomasMenos de seis semanas0
Mas de seis semanas1
Participación conjuntaUna articulación grande0
Dos a 10 articulaciones grandes.1
De una a tres articulaciones pequeñas (sin la participación de articulaciones más grandes)2
De cuatro a diez articulaciones pequeñas (sin la participación de articulaciones más grandes)3
Más de 10 articulaciones (con al menos una articulación pequeña)5
Estado serológicoRF y anti-CCP son negativos0
Baja RF y bajo anti-CCP2
Alta RF y alta anti-CCP3
Marcadores inflamatoriosNormal ESR y CRP0
ESR anormal y PCR1

Progresión

El indicador más fuerte de daño articular progresivo en la artritis reumatoide se dice que es la seropositividad.Dicho esto, la seronegatividad no excluye el daño articular progresivo.

La progresión rápida del daño articular tiende a asociarse con ser positivo tanto para el factor reumatoide como para el anti-PCC, más probable que si alguien es positivo para cualquiera de los dos, en lugar de ambos.

Los factores que apuntan a un mal pronóstico con daño articular progresivo incluyen:

(Video) ¿Quieres combatir la artritis? Mejor comer estos alimentos que tomar medicinas

  • Evidencia de rayos X o evidencia clínica de daño articular.
  • Mayor número de articulaciones involucradas con sinovitis activa, sensibilidad, hinchazón oderrames articulares
  • ESR elevado o CRP
  • Positivo para anti-PCC
  • Alto nivel de uso de medicamentos, incluidos loscorticosteroides, utilizados para tratar lainflamaciónen las articulaciones afectadas
  • Una respuesta inadecuada a los medicamentos.
  • Disminución de la función articular según lo determinado por el Cuestionario de Evaluación de la Salud
  • Disminución de la calidad de vida.

Remisión

El diagnóstico de la remisión de la enfermedad no es un proceso tan sencillo.Requiere no solo pruebas de diagnóstico, sino también una evaluación subjetiva de lo que usted, como paciente, siente acerca de su condición.El diagnóstico preciso de la remisión es importante porque determina si ciertos tratamientos pueden detenerse o si hacerlo puede ser prematuro y causar unarecaída.

Con este fin, el ACR ha establecido lo que se llama el DAS28, que consta de cuatro medidas diferentes.DAS es el acrónimo de puntuación de actividad de la enfermedad, mientras que 28 se refiere al número de articulaciones que se examinan en la evaluación.

El DAS mira lo siguiente:

  • El número de articulaciones sensibles que encuentra su médico (de 28)
  • El número de articulaciones inflamadas que su médico encuentra (de un total de 28)
  • Sus resultados de ESR y CRP (normal versus anormal)
  • Su calificación de cómo se siente / su estado de salud general como se indica en una escala que va desde “muy buena” a “muy mala”

Estos resultados luego se incorporan a una fórmula matemática compleja para calcular su puntaje general.Un DAS28 de más de 5.1 implica enfermedad activa, menos de 3.2 indica una actividad de la enfermedad baja y menos de 2.6 se considera remisión.

Diagnósticos diferenciales

De la misma manera que las pruebas pueden ayudar a diferenciar entre artritis reumatoide y osteoartritis, se pueden ordenar otras para determinar si existen otras causas de sus síntomas.Esto es especialmente cierto si los resultados de la prueba de artritis reumatoide son concluyentes, ambiguos o negativos.

Estos pueden incluir trastornos autoinmunes, enfermedades del tejido conectivo y enfermedades inflamatorias crónicas como:

  • Fibromialgia
  • enfermedad de Lyme
  • Síndromes mielodisplásicos
  • Síndromes paraneoplásicos
  • Polimialgia reumática
  • Artritis psoriásica
  • Sarcoidosis
  • Sindrome de sjögren
  • Lupus eritematoso sistémico (lupus)

Author profile

Christopher Loynes

I am Dr. Christopher Loynes and I specialize in Bone Marrow Transplantation, Hematologic Neoplasms, and Leukemia. I graduated from the American University of Beirut, Beirut. I work at New York Bone Marrow Transplantation
Hospital and Hematologic Neoplasms. I am also the Faculty of Medicine at the American University of New York.

(Video) Artritis reumatoide - síntomas y edad en la que aparece
(Video) ¿Qué es la artritis reumatoidea?

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