Diagnosing Rheumatoid Arthritis

Diagnosing rheumatoid arthritis, specifically in the early stages, is more difficult than it might seem. What are the typical rheumatoid arthritis symptoms? How do symptoms related to RA differ than other forms of arthritis symptoms? What kinds of tests are done to determine if one has rheumatoid arthritis?




Typical Rheumatoid Arthritis Symptoms

Unlike the most common type of arthritis, osteoarthritis, rheumatoid arthritis is an autoimmune disease. Whereas osteoarthritis generally only affects one joint of the body at a time, rheumatoid arthritis affects multiple joints of the body. Common symptoms of rheumatoid arthritis can include the following:

• Generalized morning joint stiffness.

• Swelling and redness around multiple joints specifically in the hands, wrist, and feet.

• Swelling and pain affecting the same joint on both sides of the body.

• Generalized fatigue.

• Rheumatoid nodules, most commonly around the elbows.

One of the challenges in diagnosing rheumatoid arthritis is that these symptoms can frequently be vague or not significant enough to consider that they may be related. Some people experience such symptoms infrequently with only occasional ‘flares’ while others can feel such symptoms on a consistent basis.

In addition, other arthritic related conditions including gout, lupus, and even fibromyalgia can mimic similar symptoms making the diagnosis difficult. In reaching a diagnosis of rheumatoid arthritis the process involves as much ruling out other potential conditions as it is ruling in RA. The average amount of time between the onset of symptoms and diagnosing RA is nine months.


What Tests Are Used For Diagnosing RA?

rheumatoid arthritis diagnosis

Unfortunately there is not one ‘RA test’ that can be used to make a definitive diagnosis. A thorough physical exam will be performed to determine the presence of joint swelling, inflammation, and limited joint range of motion.

As the history of symptoms is an important aspect of making the diagnosis, keeping a journal of when and where symptoms occur can be of great assistance to the examining doctor.

Other specific diagnostic tests will also be utilized. X-rays are performed to help determine if there has been destruction of the bones, specifically in the hands and fingers.


Rheumatoid arthritis blood tests can include testing for the amount of rheumatoid factor in the blood. In the early stages of RA, testing for rheumatoid factor may result in a ‘false negative’ meaning that the blood test does not show an elevated rheumatoid factor, despite the potential presence of rheumatoid arthritis.


What Kind of Doctor Determines the Diagnosis?

As early diagnosis is important, at the first signs of joint pain discuss these symptoms with your family doctor. A thorough examination and evaluation of your symptoms will determine if you should be referred to a specialist, most commonly a Rheumatologist. Most often it is the Rheumatologist that will direct the series of tests and make the final diagnosis.


Summary

• Diagnosing rheumatoid arthritis can be difficult as symptoms are generalized, vague, and can mimic other conditions.

• Discuss your symptoms with your doctor to help ensure early testing and potential diagnosis.

• Physical exam, symptom history, x-rays, and blood tests can all be used in helping to make the diagnosis.





Diagnosing rheumatoid arthritis is not always an easy process. Work with your doctor to ensure you understand the process and once a diagnosis is made, you have a clear understanding of your condition and treatment options.

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References

Arthritis Care Res (Hoboken). 2012 Feb 27. doi: 10.1002/acr.21650. [Epub ahead of print]The importance of the patient history and physical examination in rheumatoid arthritis in contrast to other chronic diseases: Results of a physician survey.Castrejón I, McCollum L, Tanriover MD, Pincus T.

Arthritis Care Res (Hoboken). 2010 Jun;62(6):842-7.Factors that influence rheumatologists' decisions to escalate care in rheumatoid arthritis: results from a choice-based conjoint analysis.Kievit W, van Hulst L, van Riel P, Fraenkel L.

Radiologe. 2012 Feb 1. [Epub ahead of print][Radiological imaging in early diagnosis of rheumatoid arthritis : The role of ultrasound and magnetic resonance imaging.][Article in German]Platzgummer H, Schüller-Weidekamm C.

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