What can I expect at a doctor's visit to diagnose rheumatoid arthritis?

When going to an appointment to diagnosis or evaluate rheumatoid arthritis symptoms, be prepared with your medical history and a list of questions. Your doctor will need to know details about your symptoms, such as when they started and when they occur. Family medical history and all the medications you take will be noted. The doctor will give you a physical exam during which your joints, muscle strength and reflexes will be examined. Blood tests, x-ray or MRI may also be a part of the overall examination.

If you think you may have rheumatoid arthritis (RA), you should visit a healthcare professional. He or she will take several elements into consideration before rendering a diagnosis:

• Medical history. Your description of the symptoms—including their duration and intensity—can help with the diagnosis.
• Physical examination. Your healthcare professional will do a physical exam and pay particular attention to your joints, skin, reflexes and muscle strength.
• Laboratory tests. Some lab tests can help establish the presence of RA. Your healthcare professional will probably order a test to detect rheumatoid factor (an antibody eventually present in the blood of most people with rheumatoid arthritis). It's inconclusive, however, since not all people with RA test positive for rheumatoid factor, especially in the early stages. Some people with other types of rheumatic disease and a small number of healthy individuals also have a positive rheumatoid factor test, so you could test positive and never develop the disease. A test called anti-cyclic citrullinated peptide, or anti-CCP, is now available and might be somewhat more specific than rheumatoid factors. Specificity is much higher when both tests are positive. Other common tests include one that indicates the presence of inflammation in the body (the erythrocyte sedimentation rate and the C-reactive protein), a white blood cell count and a blood test for anemia.
• X-rays. These can help determine the extent of joint destruction. If you identify RA in its early stages, X-rays may not be helpful in diagnosis. However, they can be used to monitor the disease's progress. Other imaging techniques, such as MRI and ultrasound, also may be used to assess inflammation and joint damage.