How Do Doctors Diagnose Rheumatoid Arthritis?

If your joints feel sore and swollen for weeks, and you’re especially stiff in the morning, it’s a good idea to see a doctor. He may suspect you have rheumatoid arthritis (RA).

Unlike osteoarthritis, which usually develops from age or from injury to a joint, RA is a problem with your immune system. If you don’t diagnose and treat it in time, it could harm your joints. In fact, most people with RA do have some sort of joint damage. Most of it happens in the first 2 years.

Your primary care doctor may order blood tests and X-rays to help confirm a diagnosis. Or you may be sent to someone who specializes in diagnosing and treating RA. This type of doctor is called a rheumatologist.

A Difficult Diagnosis

Sometimes, RA can be tough to figure out. Symptoms may come and go, and they aren’t the same in all people who have it. But these tend to be common:

  • Joint pain/swelling/stiffness, especially in small joints (wrists, hands, feet)
  • Discomfort for at least 6 weeks
  • Morning stiffness that lasts at least 30 minutes
  • Fatigue
  • Loss of appetite
  • Low-grade fever

There isn’t a single test that gives doctors a clear answer. And in the early stages, RA can resemble other diseases like:

That’s why your doctor will rely on many factors to help pinpoint the cause of your pain and other symptoms.

What to Expect at the Doctor

Here are some of the things you can expect to happen at your appointment if the doctor suspects you have RA.

Personal and family medical history: Your doctor will ask about your past and your relatives’. If someone in your family tree has RA, it may be more likely for you to have the disease.

Physical exam: The doctor will check your joints for swelling, tenderness, and range of motion. RA tends to strike several joints.

Antibody blood tests: Doctors look for certain proteins that show up in your blood when you have RA:

  • Rheumatoid factor (RF)
  • Anti-CCP (anti-cyclic citrullinated peptide)
  • ANA, or antinuclear antibodies

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Not all people with RA have these antibodies, however.

Other blood tests: Besides RF and anti-CCP antibodies, other blood tests could look for:

  • Complete blood count. Anemia (low red blood cells) is fairly common in RA.
  • Erythrocyte sedimentation rate and c-reactive protein. These measures of inflammation are often higher when you have RA.

Imaging tests: These can help your doctor judge how severe your disease is, and track its progress over time. X-rays can show whether (and how much) joint damage you have, though damage may not show up early on. Magnetic resonance imaging (MRI) and ultrasound give a more detailed picture of your joints. These scans aren’t normally used to diagnose RA, but they can help doctors find it early.

What Else Could It Be?

When a doctor thinks about how likely you are to have one disease over another, or over several others, this is called a differential diagnosis. There are many conditions your doctor may consider besides RA, and besides other forms of autoimmune arthritis:

Viral arthritis: Rubella, parvovirus, and hepatitis B and C can lead to short-term arthritis symptoms that resemble RA.

Palindromic rheumatism: Periodic joint inflammation that may lead to RA, lupus, and similar diseases

Polymyalgia rheumatica: This is more common over age 50, generally less painful than RA, and associated more with shoulders and hips.

What’s Next After an RA Diagnosis?

Don’t panic if you learn you have rheumatoid arthritis. While there is no cure, people are living better now with RA than ever before. Your doctor will talk to you about all the ways you can treat the disease and manage your symptoms.

Medicines: There are several types: nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying drugs.

Lower the stress on your joints: Lose weight or stay at a healthy weight. Get some rest, but not too much -- moderate activity helps, too. Use canes and walkers to take pressure off your lower body.

Surgery: If you have major joint damage over time, you may want to talk to your doctor about surgery. Total joint replacements of the knee, hip, wrist, and elbow can help. Less serious surgeries may also be good options.

WebMD Medical Reference Reviewed by David Zelman, MD on January 12, 2017

Sources

SOURCES:

Johns Hopkins Arthritis Center: “Rheumatoid Arthritis,” “Rheumatoid Arthritis Signs and Symptoms,” “Rheumatoid Arthritis Treatment.”

Arthritis Foundation: “Rheumatoid Arthritis Diagnosis,” “Rheumatoid Arthritis Symptoms.”

UpToDate: “Diagnosis and differential diagnosis of rheumatoid arthritis.”

Mayo Clinic: "Rheumatoid Arthritis: Diagnosis,” “Rheumatoid Arthritis: Symptoms and causes.”

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