Diagnosis of Rheumatoid Arthritis
Doctors diagnose RA by:
- Taking a medical history.
- Performing a physical exam.
- Ordering laboratory tests.
- Ordering imaging studies, such 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 time, and 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 result, doctors use a variety of tools to diagnose the disease and to rule out other conditions.
Remember to let your doctor know:
- About your symptoms, when and how they started, and how they have changed over time.
- What limitations in activities you may have, such as difficulty with work, leisure, or 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.
The doctor usually performs a physical exam that may include:
- Examining your joints.
- Watching how you walk, bend, and 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.
Lab tests may help to diagnose rheumatoid arthritis. Some common tests include:
- Rheumatoid factor (RF). This blood test checks for RF, an 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. However, doctors can use this test, along with other test results and evaluations, to diagnose rheumatoid arthritis.
- Anti-cyclic citrullinated peptide antibody (anti-CCP). This blood test checks for anti-CCP antibodies, which appear in many people with rheumatoid arthritis. In addition, anti-CCP can appear before RA symptoms develop, which can help doctors diagnose the disease early. This test’s results, along with the results from RF blood tests, are very useful in confirming a rheumatoid arthritis diagnosis. However, it 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 anemia, which 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 function, electrolytes, liver function, thyroid function, muscle markers, other autoimmune markers, and markers of infection to evaluate for your overall health and evaluate for other diagnoses. Other specific tests for rheumatoid arthritis, are sometimes considered.
To check for joint damage, doctors may use imaging tests such as:
- X-rays help check for RA; however, they are not generally abnormal in the early stages of rheumatoid arthritis, before 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 addition, these 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) scanning, positron emission tomography (PET) scan, bone scan, and dual-energy X-ray absorptiometry (DEXA).
Treatment of Rheumatoid Arthritis
Treatment of rheumatoid arthritis continues to improve, which can give many people relief from symptoms, improving their quality of life. Doctors may use the following options to treat RA:
- Physical therapy and occupational therapy.
- Routine monitoring and ongoing care.
- Complementary therapies.
Your doctor may recommend a combination of treatments, which may change over time based on your symptoms and the severity of your disease. No matter which treatment plan your doctor recommends, the overall goals are to help:
- Relieve pain.
- Decrease inflammation and swelling.
- Prevent, slow, or 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 occurs, it is generally cannot be reversed, so early diagnosis and treatment are very important.
Most people who have RA take medications. Studies show that early treatment with combinations of medications, instead of one medication alone, may be more effective in decreasing or preventing joint damage.
Many of the medications that doctors prescribe to treat RA help decrease inflammation and pain, and slow or stop joint damage. They may include:
- Anti-inflammatory medications to provide pain relief and lower inflammation.
- Corticosteroids that can help decrease inflammation, provide some pain relief, and slow joint damage. Because they are potent drugs and have potential side effects, your 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 modifiers, which are also DMARDs, if your disease does not respond to initial therapies. These medications target specific immune messages and interrupt the signal, helping to decrease or stop inflammation.
- Janus kinase (JAK) inhibitors, which are also DMARDs, send 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 develop, recover, improve, as well as maintain the skills needed for daily living and working. Sometimes, assistive devices or braces may be helpful to optimize movement, reduce pain, and help you maintain the ability to work.
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 tests, and x‑rays or other imaging tests. Having rheumatoid arthritis increases your risk of developing osteoporosis, particularly 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 organs, your 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:
- Rheumatologists, who specialize in autoimmune diseases, arthritis, and other diseases of the bones, joints, and muscles.
- Physician assistants, who assist doctors in diagnosing, treating, and monitoring diseases.
- Primary care providers, such as internists or nurse practitioners, who specialize in the diagnosis and medical treatment of adults.
- Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
- Other medical specialty doctors, such as pulmonologists or cardiologists, for people whose rheumatoid arthritis affects other organs such as the lungs or heart.
- Podiatrists, who specialize in the treatment of and surgery for problems in the feet.
- Physical therapists, who help to improve joint function.
- Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
- Pharmacists, who dispense medications and help check the dosing and potential for interactions with other medications.
- Dietitians, who teach ways to eat a good diet to improve health and maintain a healthy weight.
- Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
- Mental health professionals and social workers, who 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 emotional, and mental effects of rheumatoid arthritis.
Participating in your care can help build confidence in your ability to perform day-to-day activities, allowing you to lead a full, active, and independent life.
Certain activities can help improve your ability to function on your own and maintain a positive outlook.
- Rest and exercise. Balance your rest and exercise, with more rest when your RA is active and more exercise when it is not. Rest helps to decrease active joint inflammation, pain, and fatigue. In general, shorter rest breaks every now and then are more helpful than long times spent in bed. Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Exercise can help:
- Improve your sleep.
- Decrease pain.
- Keep a positive attitude.
- Maintain a healthy weight.
Doctors may sometimes recommend low-impact exercises, such 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 hands, but 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 devices, such as items with a large grip, zipper pullers, or long-handled shoehorns.
- Using tools or devices that help with activities of daily living, such as an adaptive toothbrush or silverware.
- Using devices to help you get on and off chairs, toilet seats, and beds.
- Choosing activities that put less stress on your joints, such 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 – fear, anger, and frustration, along with any pain, physical limitations, and 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 breathing, meditating, or listening to quiet sounds or music.
- Movement exercise programs, such as yoga and tai chi.
- Mental health management. Living with RA can be hard and isolating. If you feel alone, anxious, or depressed about having the disease, talk to your doctor, an RA support social worker, or 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 calories, protein, and 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 activity, talk to your doctor.