• D. G. Rekalov
  • S. Y. Dotsenko
  • A. V. Kylinich



early rheumatoid arthritis, arthrosonography, rheumatoid factor, AT-MCV


Rheumatoid arthritis (RA) leads not only to a rapid development of disability, but can influence the life of these patients. One-third of patients with rheumatoid arthritis may have signs of disability during the first 3 years of the onset of the disease, while mortality in patients with RA almost two times higher in comparison with the general population.

Analysis of recent prospective studies on the progression of the pathological process and predicting of the long-term outcomes in RA clearly indicate the need for clinical evaluation and a comprehensive laboratory and instrumental diagnosis of the disease in the initial manifestations of the most followed by early adequate pathogenetic therapy.

The purpose of this survey was to determine modern clinical aspects of diagnosis, the possibility of standard and specialized instrumental examinations in patients with eRA, followed by predicting long-term results.

We studied 52 specialized publications on clinical classification and a modern laboratory and diagnostic tests for eRA.

This review presents the data of the importance of differentiation of several stages of RA in relation to the time factor. The data on the sensitivity and specificity of the diagnostic classification and clinical criteria of eRA and an algorithm for the identification of the disease were presented.

It was shown prognostic value of the main serological markers of RA, and the predictive value for early detection of antibodies to the circulating peptide as a marker of the severity of bone-destructive changes in patients with certain clinical manifestations. Antibodies to the circulating peptide (ACPA) can be detected many years before the onset of RA. Study of anti-citrulline mutated vimentin (anti-MCV) in patients with eRA can be applied as a marker of activity of the process and the subsequent possibility of use for predicting long-term results.

This review presents the major diagnostic errors using standard instrumental methods of diagnosis of  RA. Describes the diagnostic capabilities of the periarticular soft tissue changes at different stages. Provides information about using US of joints as a methodology for monitoring patients with eRA.

The data presents the diagnostic capabilities of magnetic resonance imaging (MRI) in patients with eRA by using different modes of  MRI and radiopaque substance with a strong tropism to the synovial membrane.


  1. For the purpose of early diagnosis and prognosis of joint erosions appropriate set of laboratory monitoring indicators (ESR, CRP, RF and ACPA anti-MCV) characterize the pathological changes of the articular structure in patients with eRA.
  2. The introduction into the routine clinical practice US of joints allows to reach high accuracy of the diagnosis of eRA (before the erosive and destructive changes of bone tissue), which significantly improvement prognosis of the patients.
  3. Instrumental examination using MRI (especially in the study of small joints and muscles function T1 fs-fat) is essential for the study of the pathophysiology of objectification of patients with eRA.
  4. When conducting MRI in patients with very eRA - is diagnostic and prognostic factor in the rapid progression to erosive and destructive arthritis.


Коваленко В.М. Сучасні аспекти діагностики ревматоїдного артриту / Коваленко В.М., Борткевич О.П., Білявська Ю.В. // Здоров’я України. – 2010. – №1. – С. 74–77.

Борткевич О.П. Особливості перебігу ранньої стадії ревматоїдного артриту за даними 12-місячного проспективного спостереження / Борткевич О.П., Білявська Ю.В. // Український ревматологічний журнал. – 2009. – №1 (36). – С. 40–43.

Борткевич О.П. Cучасні аспекти імунологічної діагностики раннього ревматоїдного артриту / Борткевич О.П., Гавриленко Т.І., Білявська Ю.В., Рижкова Н.О. // Український медичний часопис. – 2009. – №І-ІІ (69). – С. 34–37.

Борткевич О.П. Клініко-діагностичне значення антитіл до циклічного цитрулінового пептиду у пацієнтів з різною тривалістю ревматоїдного артриту / Борткевич О.П., Білявська Ю.В. // Український ревматологічний журнал. – 2008. – №3 (33). – С. 58–64.

Борткевич О.П. Прогресування локальних змін кісткової тканини суглобів у хворих на ранній ревматоїдний артрит і прогнозування його перебігу / Борткевич О.П. // Український ревматологічний журнал. – 2003. – №3 (13). – С. 62–68.

Герасименко С.И. Ревматоидное поражение коленного сустава / Герасименко С.И., Скляренко Е.Т., Полулях М.В. и соавт. – К., 2004. – 140 с.

Каратеев Д.Е. Фармакотерапия раннего ревматоидного артрита / Каратеев Д.Е. // Фарматека. – 2006. – №6. – С. 1 6.

Коваленко В.М. Визначення ролі факторів аутоіммуної та імунозапальної реакції в патогенезі ревматоїдного артриту / Коваленко В.М., Гавриленко Т.І., Борткевич О.П., Рижкова О.П., Білявська Ю.В. // Український ревматологічний журнал. – 2008. – №4 (34). – C. 38–43.

Насонов Е.Л. Ревматоидный артрит как общемедицинская проблема / Насонов Е.Л. // Терапевтический Архив. – 2004. – №5. – С. 5–7.

Насонов Е.Л. Почему необходимы ранние диагностика и лечение ревматоидного артрита? / Насонов Е.Л. // Российский медицинский журнал. – 2004. – № 10 (6). – С. 5–21.

Терзов К.А. Оценка поражения суставов кистей у больных ранним ревматоидным артритом / Терзов К.А., Борткевич О.П. // Український ревматологічний журнал. – 2005. – №2 (20). – C. 45–48.

Терзов К.А. Роль ультразвукового дослідження в оцінці уражень колінних суглобів у хворих на ревматоїдний артрит / Терзов К.А., Борткевич О.П., Масик О.М. // Український ревматологічний журнал. – 2006. – №1 (23). – C. 57–61.

Чичасова Н.В. Діагностика ревматоидного артрита: Метод. реком. / Чичасова Н.В. – М., 2006. – 31 с.

Яременко О.Б. Диагностика ревматоидного артрита на ранних стадіях / Яременко О.Б., Микитенко А.М. // Здоров`я України. – 2008. – №5 (1). – С. 63–65.

Arnett F.C. The American Rhjeumatism Association 1987 revised criteria for the classifi cation of rheumatoid arthritis / Arnett F.C., Edworthy S.M., Bloch D.A. et al. // Arthritis Rheum. – 1988. – Vol. 31. – P. 315–324.

Aletaha D. Rheumatoid Arthritis Classification Criteria An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative / Aletaha D., Neogi T., Silman A. J. et al. // ARTHRITIS & RHEUMATISM. – 2010. – Vol. 62, №9. – P. 2569–2581.

Bang H. Mutation and citrullination modifi es vimentin to a novel autoantigen for rheumatoid arthritis / Bang H., Egerer K., Gauliard A., et al. // Arthritis Rheum. – 2007. – Vol. 56. – P. 2503–2511.

Brower A.C. Use of the radiograph to measure the course of rheumatoid arthritis. The gold standard versus fool’s gold / Brower A.C. // Arthritis Rheum. – 1990. – Vol. 33. – P. 316–324.

Cimmino M.A. Modern imaging techniques: a revolution for rheumatology practice / Cimmino M.A., Grassi W., Cutolo M. // Best Pract Res Clin Rheumatol. – 2008. – Vol. 22. – P. 951 959.

Coenen D. Technical and diagnostic performance of 6 assays for the measurement of citrullinated protein/peptide antibodies in the diagnosis in the diagnosis of rheumatoid arthritis / Coenen D., Verschueren P., Westhovens R., Bossuyt X. // Clin Chem. – 2007. – Vol. 53. – P. 498–504.

Dejaco C. Diagnostic value of antibodies against a modified citrullinated vimentin in rheumatoid arthritis / Dejaco C., Klotz W., Larcher H., Duftner C., Schirmer M., Herold M. // Arthritis Res Ther. – 2006. – Vol. 8.

de Vries-Bouwstra J.K.D. Biologics in early rheumatoid arthritis / de Vries-Bouwstra J.K.D., Breedveld B.A.C., Ferdinand C. // Rheum Dis Clin North Am. – 2010. – Vol. 31. – P. 745–762.

Dixon W. Does early rheumatoid arthritis exist? / Dixon W., Symmons D. // Best Practice and Research Clinical Rheumatology. – 2005. – Vol. 19 (1). – P. 37–53.

Dǿhn U.M. Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints / Dǿhn U.M., Ejbjerg B.J., Court-Payen et al. // Arthritis Res Ther. – 2006. – Vol. 8. – R110.

Dǿhn U.M. No erosive progression revealed by MRI in rheumatoid arthritis patients treated with etanercept, even in patients with persistent MRI and clinical signs of joint infl ammation / Dohn U.M., Skjodt H, Hetland M.L. et al. // Clin Rheumatol. – 2007. – Vol. 26. – P. 1857–1861.

Dǿhn U.M. Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography / Dǿhn U.M., Ejbjerg B.J., Hasselquist M. et al. // Arthritis Res Ther. – 2008. – Vol. 10. – R25.

Dörner T. Rheumatoid factor revisited / Dörner T., Ereger K., Feist E., Burmester G-R. // Curr Opin Rheumatol. – 2004. – Vol. 16. – P. 246–253.

Durez P. Treatment of early rheumatoid arthritis: a randomized magnetic resonance imaging study comparing the effects of methotrexate alone, methotrexate in combination with infl iximab, and methotrexate in combination with intravenous pulse methylprednisolone / Durez P., Malghem J., Nzeusseu T.A. et al. // Arthritis Rheum. – 2007. – Vol. 56. – P. 3919–3927.

Emery P. Rheumatoid arthritis / Emery P., Suarez-Almazor M. // Clin Evidence. – 2003. – Vol. 10. – P. 1454–1476.

Еmery P. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of clinical guide / Еmery P., Breedveld F.C., Dougados M. et al. // Ann. Rheum. Dis. – 2002. – Vol. 61. – P. 290–297.

Ereger K. The serological diagnosis of rheumatoid arthritis / Ereger K., Feist E., Burmester G-R. // Deutsches Arzteblatt International. – 2009. – Vol. 106 (10). – P. 159–163.

Filippucci E. Ultrasound imaging for the rheumatologist VII. Ultrasound imaging in rheumatoid arthritis / Filippucci E., Iagnocco A., Meenagh et al. (2007) // Clin Exp Rheumatol. – 2007. – Vol. 25. – P. 5–10.

Hoving J.L. A comparison of magnetic resonance imaging, sonography, and radiography of the hand in patients with early rheumatoid arthritis / Hoving J.L., Buchbinder R, Hall S et al. // J Rheumatol. – 2004. – Vol. 31. – P. 663–675.

Grassi W. Ultrasonography in rheumatology: an evolving technique / Grassi W., Cervini C. // Ann Rheum Dis. – 1998. – Vol. 57. – P. 268–271.

Jimenez-Boj E. Bone erosions and bone marrow edema as defi ned by magnetic resonance imaging refl ect true bone marrow inflammation in rheumatoid arthritis / Jimenez-Boj E., Nobauer-Huhmann I., Hansilk-Schnabel B. et al. // Arthritis Rheum. – 2007. – Vol. 56. – P. 1118–1124.

Knijff-Dutmer E. Rheumatoid factor measured by fluoroimmunoassay: a responsive measure of rheumatoid arthritis disease activity that is associated with joint damage / Knijff-Dutmer E., Drossaers-Bakker W., Verhoeven A., van der Sluijs Veer G., Boers M., van der Linden S., et al. // Ann Rheum Dis. – 2002. – Vol. 61. – P. 603–607.

Mathsson L. Antibodies against citrullinated vimentin in rheumatoid arthritis / Mathsson L., Mullazehl M., Wick M.C., et al. // Arthritis Rheum. – 2008. – Vol. 58. – P. 36–45.

Naredo E. Longitudinal power Doppler ultrasonographic assessment of joint infl ammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression / Naredo E., Collado P., Cruz A. et al. // Arthritis Rheum. – 2007. – Vol. 57. – P. 116–124.

Nielen M.M. Antibodies to citrullinated human fi brinogen (ACF) have diagnostic and prognostic value in early arthritis / Nielen M.M., van der Horst A.R., van Schaardenburg D., et al. // Ann Rheum Dis. – 2005. – Vol. 64. – P. 1199–1204.

Ødegard S. Association of early radiographic damage with impaired physical function in rheumatoid arthritis: a ten-year, longitudinal observational study in 238 patients / Ødegard S., Landewe R., van der Heijde D. et al. // Arthritis Rheum. – 2006. – Vol. 54. – P. 68–75.

Østergaard M. Imaging in rheumatoid arthritis-status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography / Østergaard M., Pedersen S.J., Dohn U.M. // Best Pract Res Clin Rheumatol. – 2008. – Vol. 22. – P. 1019–1044.

Perry D. Detection of erosions in the rheumatoid hand; a comparative study of multidetector computerized tomography versus magnetic resonance scanning / Perry D., Stewart N., Benton N. et al. // J Rheumatol. – 2005. – Vol. 32. – P. 256 267.

Renaudineau Y. Rheumatoid factor on a daily basis / Renaudineau Y., Jamin C., Saraux A., Youdionou P. // Autoimmunity. – 2005. – Vol. 38. – P. 11–16.

Saulot V. Presence of autoantibodies to the glycolytic enzyme alpha-enolase in sera from patients with early rheumatoid arthritis / Saulot V., Vittecoq O., Charlionet R., et al. // Arthritis Rheum. – 2002. – Vol. 46. – P. 1196–1201.

Scheel A.K. Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis fi nger joints / Scheel A.K., Hermann K.G., Ohrndorf S et al. // Ann Rheum Dis. – 2006. – Vol. 65. – P. 595–600.

Schellekens G.A. The diagnostic properties of rheumatoid arthritis antibodies recognizing a cyclic citrullinated peptide / Schellekens G.A., Visser H., de Jong B.A., et al. // Arthritis Rheu. – 2000. – Vol. 43. – P. 155–163.

Sharp J.T. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? / Sharp J.T., Young D.Y., Bluhm G.B. et al. // Arthritis Rheum. – 1985. – Vol. 28. – P. 1326 1335.

Sommer O.J. Rheumatoid arthritis: a practical guide to state-of the-art imaging, image interpretation, and clinical implications / Sommer O.J., Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. // Radiographics. – 2005. – Vol. 25. – P. 381–398.

Smolen J.S. Challenges of predicting treatment response in patients with rheumatoid arthritis / Smolen J.S., Aletaha D. // Nat Clin Pract Rheumatol. – 2005. – Vol. 1. – P. 62–63.

Usum J. Antibodies to mutated citrullinated vimentin and disease activity score in early arthritis: a cohort study / Usum J., Nielen M.M., van Schaardenburg D, et al. // Arthritis Res Ther. – 2008. – Vol. 10. – P. 124–128.

van Gaalen F.A. Association between HLA class II genes and autoantibodies to cyclic citrullinated peptides (CCPs) infl uences the severity of rheumatoid arthritis / van Gaalen F.A., van Aken J., Huizinga T.W., et al. // Arthritis Rheum. – 2004. – Vol. 50 (7). – P. 2113–2121.

Waller M. Methods of measurement of rheumatoid factor / Waller M. // Annals of the New York Academy of Sciences. – 1969. – Vol. 168. – P. 5–20.

How to Cite

Rekalov DG, Dotsenko SY, Kylinich AV. MODERN APPROACHES TO CLINICAL AND LABORATORY DIAGNOSTICS OF RHEUMATOID ARTHRITIS EARLY ONSET. Zaporozhye Medical Journal [Internet]. 2013Nov.13 [cited 2024Jul.17];15(5). Available from: