Rheumatoid Arthritis Diagnosis: What Is the Process?
Medically reviewed by David Ozeri, MD
Rheumatoid arthritis (RA) can be challenging to diagnose because its symptoms often overlap with other conditions, and there is no single definitive test for the disease. Getting a rheumatoid arthritis diagnosis often involves a series of tests, including blood tests, imaging studies like X-rays or magnetic resonance imaging scans (MRIs), and a thorough physical examination to evaluate joint swelling, tenderness, and overall symptoms, to arrive at an official diagnosis.
Early diagnosis is crucial because it allows for timely intervention and treatment, which can help slow the progression of the disease and minimize joint damage. Early treatment may also significantly improve a patient's quality of life and reduce the risk of long-term disability.
Read on to learn more about rheumatoid arthritis diagnosis.
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Steps to Getting an RA Diagnosis
Individuals often see their healthcare provider after experiencing symptoms of rheumatoid arthritis, including:
Prolonged joint pain, tenderness, swelling, or stiffness enduring for six weeks or more
Morning stiffness persisting for at least 30 minutes
Involvement of multiple joints
Symmetrical joint involvement often affects corresponding joints on both sides of the body
Typically, small joints such as wrists and specific hand and foot joints are the first to be affected. Fatigue is also common in individuals with rheumatoid arthritis.
Referral
Patients experiencing rheumatoid arthritis symptoms can typically start by getting a referral for a rheumatologist from their primary care physician or healthcare provider. A rheumatologist is a medical specialist who focuses on diagnosing and treating autoimmune and inflammatory conditions, particularly those affecting the joints and soft tissues.
These medical providers employ various diagnostic tools to confirm the presence of the disease and exclude alternative conditions.
Medical History
Your provider will likely start by asking about your medical history. They will want to know essential information concerning:
Your symptoms, including onset and progression
Your limitations in daily activities
Existing medical conditions
Family history of similar symptoms or rheumatoid arthritis, and medications used.
This information aids in making an accurate diagnosis and understanding the disease's impact on the individual's life.
Physical Examination
Your provider will also typically conduct a physical assessment to:
Examine your joints
Observe your mobility and activities of daily living
Inspect the skin for rashes or nodules, and
Listen to your chest to detect lung inflammation
Blood Testing
Various blood tests are used to diagnose rheumatoid arthritis, including:
Complete blood count (CBC): This blood test measures many parts of your blood, including red and white blood cells, platelets, hemoglobin, hematocrit, and the size of the blood cells.
Rheumatoid factor (RF): This blood test looks for rheumatoid factor proteins made by the immune system. Some people may have RF in their blood and still be completely healthy. However, high levels, along with other symptoms and tests, may point to a rheumatoid arthritis diagnosis.
Anti-cyclic citrullinated peptide antibody (anti-CCP): A blood test that measures the presence of anti-CCP antibodies in the blood. These antibodies target citrulline, an amino acid that can be found in joint tissues. Elevated levels of anti-CCP antibodies in the blood are strongly associated with the presence of rheumatoid arthritis, and their presence can help confirm the diagnosis, especially in the early stages of the disease.
Erythrocyte sedimentation rate: This is a common blood test used to measure inflammation in the body.
C-reactive protein: This blood test checks for C-reactive protein, a protein made by the liver. Higher levels of C-reactive protein indicate inflammation in the body.
Imaging Tests
Imaging tests play an important role in diagnosing and evaluating rheumatoid arthritis by providing visual information about joint damage and disease progression. The main imaging tests used in diagnosing and monitoring rheumatoid arthritis are:
X-Rays: X-rays are commonly used to assess joint damage in rheumatoid arthritis. However, they may not show abnormalities in the early stages of the disease before significant joint damage has occurred. X-rays are more useful for monitoring disease progression over time and ruling out other causes of joint pain.
Magnetic resonance imaging (MRI): MRI scans can provide detailed images of the joints, making them a valuable tool for diagnosing rheumatoid arthritis, especially in its early stages. MRIs can detect joint inflammation and damage.
Ultrasound: Like MRI, ultrasound can detect joint inflammation in rheumatoid arthritis. This imaging technique may be more helpful in examining the small joints of the hands and feet.
Computed tomography (CT) scans: CT scans are less commonly used than X-rays, MRIs, or ultrasound in making rheumatoid arthritis diagnoses. They may be used in specific cases, such as when an MRI is contraindicated.
Positron-emission tomography (PET) scan: PET scans are not routine in rheumatoid arthritis diagnosis but can be used to assess the extent of inflammation and disease activity throughout the body. They may help determine the overall impact of rheumatoid arthritis and its response to treatment.
Bone scan: Bone scans can help identify areas of increased bone activity and inflammation.
Dual-energy X-ray absorptiometry (DEXA): DEXA scans are primarily used to assess bone density and the risk of osteoporosis, which can be a concern in individuals with rheumatoid arthritis.
Results
It is important to understand that there is no single definitive test to diagnose rheumatoid arthritis. Instead, the diagnosis of rheumatoid arthritis typically relies on a combination of clinical evaluation, medical history, and various laboratory and imaging tests.
This is because the symptoms of rheumatoid arthritis can vary from person to person, and they can overlap with symptoms of other conditions, making it challenging to diagnose with just one test.
Rheumatologists typically use a combination of information to arrive at a diagnosis, taking into account factors such as:
Joint involvement
Duration of symptoms
Presence of inflammatory markers in blood tests and
Evidence of joint damage in imaging studies
Benefits of Early RA Diagnosis
Early diagnosis of rheumatoid arthritis is crucial because it provides the opportunity for timely and tailored intervention, helping to control inflammation, prevent joint damage, and improve the overall well-being and quality of life for individuals with rheumatoid arthritis.
Additional benefits include:
Pain and symptom management
Improved disease management
Reduced risk of disability
Improved quality of life
Increase patient education and support
In addition, early diagnosis helps healthcare providers assess the effectiveness of medications and make adjustments as needed.
Risks of Undiagnosed Rheumatoid Arthritis
Without timely diagnosis and treatment, rheumatoid arthritis can lead to progressive joint damage, deformities, and persistent pain, resulting in a diminished quality of life. Untreated rheumatoid arthritis can cause also cause functional impairment and reduced mobility, making daily activities increasingly challenging and may even limit a person's independence.
Furthermore, undiagnosed RA in people can eventually lead to complications affecting other body systems, including the cardiovascular system, lungs, and prolonged infections from the immune system focusing on attacking the joints instead of fighting infections.
How Old Are People When Diagnosed With RA?
About 70% of people living with rheumatoid arthritis are women, and 55% are over 55 years of age. Signs of rheumatoid arthritis most commonly arise in women between the ages of 30 and 60 years and is rarely seen in men under the age of 55.
After Rheumatoid Arthritis Diagnosis: Next Steps
The good news is that healthcare providers have effective medications to treat the symptoms of rheumatoid arthritis. Artificial joints may also help restore function in joints damaged by rheumatoid arthritis.
However, there are also many things you can do to help improve you quality of life following your diagnosis, including:
Follow your healthcare providers treatment plan.
Get regular physical activity.
Follow a healthy diet and keep weight under control.
Get enough sleep and manage stress.
It is also important to be an active participant in your own care. Take notes at your appointments, and make sure you write down questions and symptoms you experience between appointments.
Summary
Diagnosing rheumatoid arthritis is a complex process, given the lack of a single, definitive test and because symptoms may overlap with other conditions. Rheumatoid arthritis is diagnosed through clinical evaluation, medical history, and various laboratory and imaging tests.
Early diagnosis is essential for effective rheumatoid arthritis management and improving the patient's overall quality of life. If you or someone you love is experiencing rheumatoid arthritis symptoms, talk to your healthcare provider for further guidance.
Read the original article on Verywell Health.
