(1) Routine examination: rheumatism is a disease that invades multiple systems and organs of the body, so it is necessary to make a comprehensive examination of the patient, blood, urine, stool, blood sedimentation, CRP, comprehensive biochemical examination (liver function, renal function, myosin profile, etc.).
(2) Serological tests: ① General: RF, C3, C4, CH50, CIC, IgG, IgA, IgM, IgE. ② Specific: a. The antinuclear antibody spectrum is very important for the diagnosis and differential diagnosis of rheumatic diseases. Generally, ANA should be done first, if the titer > 1:40, then other items should be further examined. b. HLA: Although HLA has close correlation with rheumatic diseases, but at present, there is not much understanding of it, commonly used, more specific, such as HLA B-27 can be as high as 81.8% of the positivity rate of AS, and can reach 40% of the Wright's syndrome, and in psoriasis only 10%; DR4/DR1 positive rate of RA; DR4/DR1 positive rate of RA; DR4/DR1 positive rate of RA. DR1 is 49-79% positive for RA and 7% for JRA, but 26% for Dw4 and 47% for Dw14 in JRA, and DR3 is only 2.7% in SLE and 5.6% in pSS. Behcet's disease is only 3.3% HLA B5 positive. c. Others: such as anti-keratin antibody (AKA), anti-histone antibody (Anti-histone antibody), anti-phospholipid antibody, anti-nuclear peripheral factor (ANCA) are diagnostic references for some diseases.
(3) Joint fluid examination: fresh joint fluid is very important and should be routinely, culture, serologic and immunologic examination. (1) X-ray film: generally used positive, lateral, large and small joints can be, limbs, shoulder, spine, sacroiliac joints; according to different diseases and parts of the body, there are also different requirements, the damage to the bone or hyperplasia lesions are generally shown clearly, but due to the overlap of the image, it is not easy to see the small lesions in the early stages of the disease; synovial membrane, the joint capsule, cartilage, meniscus, ligament is not shown.
(2) Computed tomography (CT): can accurately show the small differences in density of different tissues in a cross-section, which is an ideal method to observe the small lesions of bone, joint and soft tissue. It is mostly used for sacroiliac joints and spine in AS; cartilage and meniscus lesions in knee joints, brain changes in SLE; early interstitial changes in lungs, and so on.
(3) Magnetic **** vibration imaging (MRI): bone joint and soft tissue lesions, has a higher resolution than X-ray, CT, soft tissue imaging is better than CT. mostly used to observe the bone, cartilage, meniscus, fascia diagnosis; brain tissue, spinal cord disease is also very helpful.
(4) Imaging: ①Arthrography: generally use filtered air or organic iodine solution, can also be used at the same time, known as double contrast imaging. It can show structures such as articular cartilage, meniscus, synovium and ligaments. It is very helpful in the diagnosis of intra-articular lesions, and is mostly used in large joints of the limbs, but is less frequently used now. ② Angiography: divided into arteriography and venography, very helpful in the diagnosis of aortitis or vasculitis.
(5) Arthroscopy: can directly observe the lesions of various tissues in the joints, especially for the diagnosis and differential diagnosis of synovitis, has great significance. If necessary, synovial biopsy and surgical treatment can be taken.
(6) Biopsy: In cases where diagnosis is difficult, this examination can help confirm the diagnosis. Such as skin, lip mucosa, kidney, liver, synovial joints, blood vessels, muscle, bone, cartilage and so on. Sometimes also for immunohistochemical staining.
(7) Isotope bone scan: It is very helpful in identifying osteoma (primary or secondary), myeloma.
(8) Ultrasound: It is useful to determine the thickness of the joint capsule, cartilage, synovial membrane, and fluid accumulation.