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How is rheumatoid arthritis (RA) diagnosed?

To diagnose rheumatoid arthritis, your doctor will do a physical examination. He or she may order imaging tests such as x-rays, MRI or CT scans.
Rheumatoid arthritis (RA) can be difficult to diagnose in its initial stages, but an early diagnosis can be crucial to limiting its progress and severity. Some studies indicate that rheumatoid arthritis causes the most joint damage in the first two years.

There is no single test to determine if you have RA. The symptoms often are similar to those of other types of arthritis and joint conditions. The types of symptoms you experience -- and the severity -- may differ markedly from those of another person with RA. To make matters more confusing, symptoms can vary in the same person: Symptoms develop over time, and only a few may be present in the early stages of RA.

Often, RA is diagnosed by recognizing the type and pattern of joint involvement; it is a hallmark of RA, for example, if the same areas are affected symmetrically on both sides of the body.
A diagnosis of rheumatoid arthritis is based on a combination of:
  • Symptoms
  • Medical history
  • Physical examination
  • Blood tests
  • Imaging (x-ray, MRI, CT scan, or ultrasound)

In the United States, a definitive diagnosis is usually based on blood tests and six weeks of symptoms, but there has recently been some discussion of changing this to three weeks of symptoms in order to get people into treatment earlier.

Your doctor is likely to begin the appointment by asking about your symptoms -- what brought you in. Be as specific as possible about your joint pain and stiffness: when it hurts, where it hurts, how it feels, and whether your symptoms are interfering with your daily activities. Tell your doctor if you're taking any medications or nutritional supplements and whether they've affected your symptoms.

Your doctor will probably do a thorough exam to check your temperature, blood pressure, reflexes, muscle strength, lungs, skin, nails, eyes, mouth, and nose. And of course, your joints: Are they inflamed, swollen, tender, stiff? Is your range of movement limited?

Blood tests can be used to help diagnose rheumatoid arthritis, but no single test is definitive. One test looks for rheumatoid factor, an antibody protein produced by your immune system. Rheumatoid factor is found in most -- but not all -- people with rheumatoid arthritis and may not be present in the early stages of the disease. It's also possible to have this antibody in your blood without having rheumatoid arthritis.

A second blood test measures the erythrocyte (red blood cell) sedimentation rate -- also called ESR or sed rate. This is likely to be higher than normal if rheumatoid arthritis is causing inflammation in your body.

And a third test looks for anti-CCP antibodies. Like rheumatoid factor, these antibodies are present in many, but not all, people with RA, and it's possible to have these antibodies without having rheumatoid arthritis.

X-rays can be a useful tool for distinguishing between rheumatoid arthritis, osteoarthritis, and other conditions. However, early rheumatoid arthritis does not always appear on x-rays, because bone damage may not yet be visible. Magnetic resonance imaging (MRI), CT scans, and ultrasound may be better at identifying the early signs of rheumatoid arthritis.

If rheumatoid arthritis is diagnosed, this initial exam also sets a baseline, or reference point, for monitoring changes in your health and adjusting treatments accordingly.

In diagnosing rheumatoid arthritis, your doctor will give you a physical exam and take a history of your symptoms. Since the symptoms of rheumatoid arthritis can suggest other diseases too, your doctor may take x-rays or do an MRI to get images of the joints. There are also blood tests that aid in diagnosis. One blood test determines whether there is inflammation anywhere in the body, while another looks for an antibody that is present specifically with rheumatoid arthritis.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.