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Diagnosing Rheumatoid Arthritis
Diagnosing rheumatoid arthritis (RA), in the early stages, can be difficult. There is no single test that can clearly identify rheumatoid arthritis. Instead, doctors diagnose rheumatoid arthritis based on factors that are strongly associated with this disease. The American College of Rheumatology uses this list of criteria:
- Morning stiffness in an around the joints for at least one hour.
- Swelling or fluid around three or more joint areas simultaneously.
- At least one swollen area in the wrist, hand, or finger joints.
- Swelling or fluid of the same joint on both sides of body (symmetric arthritis).
- Rheumatoid nodules, firm lumps in the skin of people with rheumatoid arthritis, usually in pressure points of the body, most commonly the elbows.
- Abnormal amounts of serum rheumatoid factor in the blood.
- X-ray changes in the hands and wrists typical of rheumatoid arthritis, with wearing away of bone around the involved joints.
Rheumatoid arthritis is officially diagnosed if four or more of these seven factors are present. The first four must have been present for six weeks.
These criteria are helpful, but diagnosing rheumatoid arthritis is still difficult.
Symptoms can come and go. To diagnose RA your doctor may need to see your joints when the disease is active for several reasons:
- Patients may find it hard to describe symptoms to doctors in a way that allows them to make the diagnosis.
- Rheumatoid arthritis can appear similar to other common causes of joint pain, leading to the wrong diagnosis.
- Patients often think they are feeling "normal" aches and pains and ignore or just live with their symptoms for a long time before seeking treatment.
Several diseases can masquerade as rheumatoid arthritis, which contributes to the difficulty in diagnosis. They include:
- Osteoarthritis, or "regular" arthritis
- Gout
- Fibromyalgia
- Other autoimmune diseases such as systemic lupus erythematosus (lupus)
- Joint inflammation caused by infections
Because of these difficulties, a proper diagnosis is often missed early on. In fact, the average time between the onset of symptoms and the official diagnosis of rheumatoid arthritis is almost nine months!
Though diagnosing rheumatoid arthritis isn't easy, it is extremely important. Delaying the diagnosis can be harmful because joint damage can occur early in the disease. Some experts think that limiting this early joint damage can have huge long-term benefits.
The problem arises when it looks like someone has rheumatoid arthritis but they don't yet meet the criteria for diagnosis. If someone doesn't actually have it, it would be wrong to treat them because the medicines are powerful and can have serious side effects.
If you or your doctor suspects rheumatoid arthritis, your doctor will follow a road map to either diagnose or rule out the disease. It will take time, but eventually you will have a definite answer. There is some information and a few tools that are valuable to doctors in diagnosing rheumatoid arthritis.
- A careful history. Take note of the frequency, severity, and time of day of your symptoms. Pass this information on to your doctor.
- A physical examination. Your doctor will look closely at your joints to detect signs of inflammation or damage.
- Laboratory tests. These can include tests for inflammation in your blood or joint fluid.
- X-rays. While not always helpful right away, they can be useful at identifying any joint damage that has already occurred.
In early rheumatoid arthritis, there are no instant answers, either for you or your doctors. The best strategy is close follow-up by a physician. If you think you have rheumatoid arthritis, see a rheumatologist or consult with your primary care doctor, and visit regularly.
WebMD Medical Reference
Rheumatoid Arthritis Guide 
- Learn about Treatment for Moderate to Severe Rheumatoid Arthritis (RA)
- Is This RA Treatment Right For You?
- Some Fast Facts
Important Safety Information you should know about HUMIRA® (adalimumab).
Serious infections have happened in patients receiving HUMIRA. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections.
Before starting HUMIRA:
Tell your doctor if you think you have an infection, are being treated for an infection, have signs of an infection (such as a fever, cough, or flu-like symptoms), have any open sores on your body, have warm, red, or painful skin, get a lot of infections or have infections that keep coming back, have or had hepatitis B infection, take the medicine Kineret (anakinra), have TB or have been in close contact with someone who has TB, have lived in an area where TB or histoplasmosis is common, or were born in, lived in or traveled where there is more risk for getting TB. Your doctor should test you for TB before starting HUMIRA. If your doctor prescribes any medicine for the treatment of TB, you should start taking it before starting HUMIRA and take the full course of TB medicine prescribed.
Tell your doctor if you have any numbness or tingling, or have a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome, have heart failure or other heart conditions, are scheduled for major surgery, are pregnant, become pregnant, plan to become pregnant or are breastfeeding. Tell your doctor if you are allergic to HUMIRA or any of its ingredients or are allergic to rubber or latex. The needle cover of the prefilled syringe and the pen contain dry natural rubber.
Also, tell your doctor if you have recently received or are scheduled for any vaccines. Except for live vaccines, patients may still receive vaccines while on HUMIRA. It is recommended that children with juvenile idiopathic arthritis be brought up to date with all immunizations prior to starting HUMIRA.
After starting HUMIRA:
Call your doctor right away if you get an infection, or any sign of an infection including a fever, feeling very tired, cough, flu-like symptoms, warm, red or painful skin or if you have any open sores on your body. HUMIRA can make you more likely to get infections or make any infection that you may have worse.
Possible side effects of HUMIRA:
Serious side effects, which sometimes lead to death, have happened in patients taking HUMIRA.
- Serious infections. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria. Your doctor will examine you for TB and perform a test to see if you have TB. If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with HUMIRA and during treatment with HUMIRA. Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking HUMIRA. Patients who had a negative TB skin test before receiving HUMIRA have developed active TB. Tell your doctor if you have any of the following symptoms while taking or after taking HUMIRA: cough, low-grade fever, weight loss, or loss of body fat and muscle.
- Certain types of cancer. There have been cases of certain kinds of cancer in patients taking HUMIRA or other TNF blockers. Patients with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma. Some patients receiving HUMIRA have developed types of cancer called non-melanoma skin cancer (basal cell cancer and squamous cell cancer of the skin), which are generally not life threatening if treated. Tell your doctor if you have a bump or open sore that doesn't heal.
- Allergic reactions. Signs of a serious allergic reaction include skin rash, a swollen face, or trouble breathing.
- Hepatitis B virus reactivation in patients that carry the virus in their blood. Tell your doctor if you have any of the following symptoms: feel unwell, poor appetite, fatigue, fever, rash or joint pain.
- Nervous system problems. Signs and symptoms include: numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
- Blood problems. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
- New heart failure or worsening heart failure you already have. Symptoms include shortness of breath or swelling of your ankles or feet, or sudden weight gain.
- Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.
Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with HUMIRA may be stopped.
Common side effects of HUMIRA are: injection site reactions (redness, rash, swelling, itching or bruising), upper respiratory infections (sinus infections), headaches, rash and nausea.
These are not all the side effects with HUMIRA. Ask your doctor or pharmacist for more information.
Information You Should Know About HUMIRA® (adalimumab).
HUMIRA is used to reduce the signs and symptoms of moderate to severe rheumatoid arthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of moderate to severe polyarticular juvenile idiopathic arthritis in children 4 years of age and older. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of psoriatic arthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of ankylosing spondylitis in adults. HUMIRA is used to reduce the signs and symptoms of moderate to severe Crohn's disease in adults who have not responded well to conventional treatments. HUMIRA is also for these adults with moderate to severe Crohn's disease who have lost response or are unable to tolerate infliximab. HUMIRA is used to treat moderate to severe chronic (lasting a long time) plaque psoriasis in adults who are under the ongoing care of a physician, have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).
HUMIRA is taken by injection.
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