Diagnosis of Rheumatoid Arthritis
Doctors diagnose RA by:
- Taking a medical history.
- Performing a physical exam.
- Ordering laboratory tests.
- Ordering imaging studiessuch as x-rays or ultrasound.
It can be difficult to diagnose rheumatoid arthritis when it is in the early stages because:
- The disease develops over timeand only a few symptoms may be present in the early stages.
- There is no single test for the disease.
- Symptoms differ from person to person.
- Symptoms can be similar to those of other types of arthritis and joint conditions.
As a resultdoctors use a variety of tools to diagnose the disease and to rule out other conditions.
Medical History
Remember to let your doctor know:
- About your symptomswhen and how they startedand how they have changed over time.
- What limitations in activities you may havesuch as difficulty with workleisureor activities around the house.
- About your other medical problems.
- If you have any family members with similar symptoms or if any family members have rheumatoid arthritis.
- What medications you take.
Answers to these questions can help your doctor make a diagnosis and understand the impact the disease has on your life.
Physical Examination
The doctor usually performs a physical exam that may include:
- Examining your joints.
- Watching how you walkbendand carry out activities of daily living.
- Looking for a rash or nodules on your skin.
- Listening to your chest for signs of inflammation in the lungs.
Laboratory Tests
Lab tests may help to diagnose rheumatoid arthritis. Some common tests include:
- Rheumatoid factor (RF). This blood test checks for RFan antibody that many people with rheumatoid arthritis can eventually have in their blood. An antibody is a special protein made by the immune system that normally helps fight invaders in the body. Not all people with RA test positive for RF; some people test positive for RF but never develop the disease; and some people test positive but have another disease. Howeverdoctors can use this testalong with other test results and evaluationsto diagnose rheumatoid arthritis.
- Anti-cyclic citrullinated peptide antibody (anti-CCP). This blood test checks for anti-CCP antibodieswhich appear in many people with rheumatoid arthritis. In additionanti-CCP can appear before RA symptoms developwhich can help doctors diagnose the disease early. This test’s resultsalong with the results from RF blood testsare very useful in confirming a rheumatoid arthritis diagnosis. Howeverit is important to know that some people have rheumatoid arthritis even with normal blood tests.
- Complete blood count. This blood test measures different blood cell counts and can help diagnose anemiawhich is common in people with RA.
- Erythrocyte sedimentation rate (often called the sed rate). This test measures inflammation in the body and monitors disease activity and response to treatments.
- C-reactive protein. This is another common test for inflammation that can help diagnose rheumatoid arthritis and monitor disease activity and response to treatments.
- Other blood tests. Your doctor may also use other tests to check your kidney functionelectrolytesliver functionthyroid functionmuscle markersother autoimmune markersand markers of infection to evaluate for your overall health and evaluate for other diagnoses. Other specific tests for rheumatoid arthritisare sometimes considered.
Imaging Tests
To check for joint damagedoctors may use imaging tests such as:
- X-rays help check for RA; howeverthey are not generally abnormal in the early stages of rheumatoid arthritisbefore joint damage occurs. Doctors may use x-rays to monitor the progression of the disease or to rule out other causes for the joint pain.
- Magnetic resonance imaging (MRI) and ultrasound may help diagnose rheumatoid arthritis in the early stages of the disease. In additionthese imaging tests can help evaluate the amount of damage in the joints and the severity of the disease.
- Other imaging tests sometimes considered for rheumatoid arthritis include computed tomography (CT) scanningpositron emission tomography (PET) scanbone scanand dual-energy X-ray absorptiometry (DEXA).
Treatment of Rheumatoid Arthritis
Treatment of rheumatoid arthritis continues to improvewhich can give many people relief from symptomsimproving their quality of life. Doctors may use the following options to treat RA:
- Medications.
- Physical therapy and occupational therapy.
- Surgery.
- Routine monitoring and ongoing care.
- Complementary therapies.
Your doctor may recommend a combination of treatmentswhich may change over time based on your symptoms and the severity of your disease. No matter which treatment plan your doctor recommendsthe overall goals are to help:
- Relieve pain.
- Decrease inflammation and swelling.
- Preventslowor stop joint and organ damage.
- Improve your ability to participate in daily activities.
Rheumatoid arthritis may start causing joint damage during the first year or two that a person has the disease. . Once joint damage occursit is generally cannot be reversedso early diagnosis and treatment are very important.
Medications
Most people who have RA take medications. Studies show that early treatment with combinations of medicationsinstead of one medication alonemay be more effective in decreasing or preventing joint damage.
Many of the medications that doctors prescribe to treat RA help decrease inflammation and painand slow or stop joint damage. They may include:
- Anti-inflammatory medications to provide pain relief and lower inflammation.
- Corticosteroids that can help decrease inflammationprovide some pain reliefand slow joint damage. Because they are potent drugs and have potential side effectsyour doctor will prescribe the lowest dose possible to achieve the desired benefit.
- Disease-modifying antirheumatic drugs (DMARDs) that can help to slow or change the progression of the disease.
- Biologic response modifierswhich are also DMARDsif your disease does not respond to initial therapies. These medications target specific immune messages and interrupt the signalhelping to decrease or stop inflammation.
- Janus kinase (JAK) inhibitorswhich are also DMARDssend messages to specific cells to stop inflammation from inside the cell. These medications may also be considered if your disease does not respond to initial therapies.
Physical Therapy and Occupational Therapy
Your doctor may recommend physical therapy and occupational therapy. Physical therapy can help you regain and maintain overall strength and target specific joints that bother you. Occupational therapy can help developrecoverimproveas well as maintain the skills needed for daily living and working. Sometimesassistive devices or braces may be helpful to optimize movementreduce painand help you maintain the ability to work.
Surgery
Your doctor may recommend surgery if you have permanent damage or pain that limits your ability to perform day-to-day activities. Surgery is not for everyone. You and your doctor can discuss the options and choose what is right for you.
Your doctor will consider the following before recommending surgery:
- Your overall health.
- The condition of the affected joint or tendon.
- The risks and benefits of the surgery.
Types of surgery may include joint repairs and joint replacements.
Routine Monitoring and Ongoing Care
Regular medical care is important because your doctor can:
- Monitor how the disease is progressing.
- Determine how well the medications are working.
- Talk to you about any side effects from the medications.
- Adjust your treatment as needed.
Monitoring typically includes regular visits to the doctor. It also may include blood and urine testsand x‑rays or other imaging tests. Having rheumatoid arthritis increases your risk of developing osteoporosisparticularly if you take corticosteroids. Osteoporosis is a bone disease that causes the bones to weaken and easily break. Talk to your doctor about your risk for the disease and the potential benefits of calcium and vitamin D supplements or other osteoporosis treatments.
Since rheumatoid arthritis can affect other organsyour doctor may also monitor you for cardiovascular or respiratory health. Many of the medications used to treat rheumatoid arthritis may increase the risk of infection. Doctors may monitor you for infections. Vaccines may be recommended to lower the risk and severity of infections.
Who Treats Rheumatoid Arthritis?
Diagnosing and treating rheumatoid arthritis requires a team effort involving you and several types of health care professionals. These may include:
- Rheumatologistswho specialize in autoimmune diseasesarthritisand other diseases of the bonesjointsand muscles.
- Physician assistantswho assist doctors in diagnosingtreatingand monitoring diseases.
- Primary care providerssuch as internists or nurse practitionerswho specialize in the diagnosis and medical treatment of adults.
- Orthopaedistswho specialize in the treatment of and surgery for bone and joint diseases or injuries.
- Other medical specialty doctorssuch as pulmonologists or cardiologistsfor people whose rheumatoid arthritis affects other organs such as the lungs or heart.
- Podiatristswho specialize in the treatment of and surgery for problems in the feet.
- Physical therapistswho help to improve joint function.
- Occupational therapistswho teach ways to protect jointsminimize painperform activities of daily livingand conserve energy.
- Pharmacistswho dispense medications and help check the dosing and potential for interactions with other medications.
- Dietitianswho teach ways to eat a good diet to improve health and maintain a healthy weight.
- Nurse educatorswho specialize in helping people understand their overall condition and set up their treatment plans.
- Mental health professionals and social workerswho help people cope with difficulties in the home and workplace that may result from their medical conditions.
Living With Rheumatoid Arthritis
Research shows that people who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life.
Self-care can help you play a role in managing your RA and improving your health. You can:
- Learn about rheumatoid arthritis and its treatments.
- Use exercises and relaxation techniques to reduce your pain and help you stay active.
- Communicate well with your health care team so you can have more control over your disease.
- Reach out for support to help cope with the physical emotionaland mental effects of rheumatoid arthritis.
Participating in your care can help build confidence in your ability to perform day-to-day activitiesallowing you to lead a fullactiveand independent life.
Life Changes
Certain activities can help improve your ability to function on your own and maintain a positive outlook.
- Rest and exercise. Balance your rest and exercisewith more rest when your RA is active and more exercise when it is not. Rest helps to decrease active joint inflammationpainand fatigue. In generalshorter rest breaks every now and then are more helpful than long times spent in bed. Exercise is important for maintaining healthy and strong musclespreserving joint mobilityand maintaining flexibility. Exercise can help:
- Improve your sleep.
- Decrease pain.
- Keep a positive attitude.
- Maintain a healthy weight.
Doctors may sometimes recommend low-impact exercisessuch as water exercise programs. Talk to your health care providers before beginning any exercise program.
- Joint care. Some people find wearing a splint for a short time around a painful joint reduces pain and swelling. People use splints mostly on wrists and handsbut also on ankles and feet. Talk to your doctor or a physical or occupational therapist before wearing a splint. Other ways you can protect your joints include:
- Using self-help devicessuch as items with a large gripzipper pullersor long-handled shoehorns.
- Using tools or devices that help with activities of daily livingsuch as an adaptive toothbrush or silverware.
- Using devices to help you get on and off chairstoilet seatsand beds.
- Choosing activities that put less stress on your jointssuch as limiting the use of the stairs or taking rest periods when walking longer distances.
- Maintaining a healthy weight to help lower the stress on your joints.
- Monitoring of symptoms. It is important to monitor your symptoms for any changes or the development of new symptoms. Understanding your symptoms and how they may change can help you and your doctor manage your pain when you have a flare.
- Stress management. The emotions you may feel because of RA – fearangerand frustrationalong with any painphysical limitationsand the unpredictable nature of flares – can increase your stress level. Stress can make living with the disease more difficult. Stress also may affect the amount of pain you feel. Ways to cope with stress can include:
- Regular rest periods.
- Relaxation techniques such as deep breathingmeditatingor listening to quiet sounds or music.
- Movement exercise programssuch as yoga and tai chi.
- Mental health management. Living with RA can be hard and isolating. If you feel aloneanxiousor depressed about having the diseasetalk to your doctoran RA support social workeror mental health professional. Keep the lines of communication open. Talk to family and friends about your RA to help them understand the disease. You may find it helpful to join an online or community support group.
- Healthy diet. A healthy and nutritious diet that includes a balance of caloriesproteinand calcium is important for maintaining overall health. Talk to your doctor about drinking alcoholic beverages because they may interact with the medications you take for rheumatoid arthritis.
Before making any changes to your diet or activitytalk to your doctor.