How Do Doctors Diagnose Rheumatoid Arthritis

How is Rheumatoid Arthritis Diagnosed? | Johns Hopkins Rheumatology

There is no single test that shows whether you have RA. Your doctor will give you a checkup, ask you about your symptoms, and possibly perform X-rays and blood tests.

Rheumatoid arthritis is diagnosed from a combination of things, including:

The location and symmetry of painful joints, especially the hand joints
Joint stiffness in the morning
Bumps and nodules under the skin
Results of X-rays and blood tests

Joint Pain & Tenderness

Typically, joint pain is felt during times when the disease is active and the inflammation is irritating the joint, ultimately causing the pain .

Conversely, pain can also be felt when the disease isnt active because of past damage that has been done to the joints in the body. This is similar to pain from old sports injuries in the elbows, knees, and other joints.

In addition to outright pain, RA patients may also notice that their joints feel tender to the touch. This occurs when the inflammation in the joint tissue has affected the nerves within the joint capsule. In this case, any pressure placed on the jointseven slight compression during sleepcan elicit immediate pain.

Pain and tenderness may be felt if arthritic disease has settled into the bones in the cervical spine the vertebrae in the neck area of the spinal cord, or more specifically in the atlanto-axial joint .

It is the pain associated with RA that sends many patients in search of effective treatment options. Fortunately, there are quite a fewmany of which include nonsteroidal anti-inflammatory drugs or disease-modifying antirheumatic drugs providing RA patients some much-needed pain relief.

What Is Involved In Reviewing Your Medical History And Your Current Symptoms

When reviewing your medical history, your healthcare provider may ask the following questions:

Have you had any illnesses or injuries that may explain the pain?
Is there a family history of arthritis or other rheumatic diseases?
What medication are you currently taking?

Your healthcare provider may also ask:

What symptoms are you having? For example, pain, stiffness, difficulty with movement, or swelling.
About your pain:
What makes it worse?

You Can Have Psoriasis And A Different Kind Of Arthritis That Is Not Psa

People with psoriasis can develop different types of arthritis including rheumatoid arthritis, gout, osteoarthritis, and reactive arthritis so diagnosing PsA involves ruling out those other conditions.

Its often difficult to say in a first visit whether a patient definitely has psoriatic arthritis or another type of arthritis that just co-exists with psoriasis, says Dr. Kumar. PsA can take a long time to diagnose because a patient can delay seeing the doctor, then confirming PsA can require multiple labs and imaging tests.

The good news is that the diagnosis process for psoriatic arthritis is improving. Whereas PsA wasnt even recognized as a distinct condition decades ago , doctors are now better equipped with improved lab tests and imaging studies that help identify this disease so more patients can find relief.

Rheumatoid Arthritis Classification Criteria

To help doctors make diagnoses, the American College of Rheumatology and the European League Against Rheumatism collaborated to create the 2010 Rheumatoid Arthritis Classification Criteria.

These criteria set a minimum standard for what signs and symptoms must be noted before RA can be diagnosed.2 A total point score of 6 or more indicates rheumatoid arthritis.

Joints Affected
Normal C-reactive protein and normal erythrocyte sedimentation rate
1 point	Abnormal CRP or abnormal ESR

Points may be added over time or retrospectively, meaning the signs and symptoms do not necessarily have to be recorded at the same doctors appointment.

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I Got Diagnosed As A Baby

When I was just a baby my mom noticed that I hardly ever turned my head and mentioned it at my checkup. The doctor said he thought it was a muscular imbalance but my mom insisted on having it checked, says Jocelyn S., 23. And its a good things she did: Jocelyn was just a year old when she was diagnosed with juvenile arthritis.

The arthritis appeared to affect just her neck at first but by elementary school she was having problems chewing, which eventually lead to surgery on her jaw joints. Although she says she experienced frequent bouts of pain and swelling, middle and high school went pretty normally.

Sometimes I had to get my knees drained but overall it didnt seem like a huge deal, she says.

However, in college her disease progression suddenly sped up and now she has trouble walking. Occasionally she needs a wheelchair on really bad days. Her doctor says she is looking at a double hip replacement in her future.

Ive tried every drug in the book and eventually they all stop working or I develop a reaction to them, she says. Still though, she finds ways to keep her spirits up, going to concerts and hanging out with friends.

Honestly arthritis is all Ive ever known so Im not too sad about it because I dont have anything to compare it to, she says. I just try to live my life and not worry about the future.

Joint Redness & Warmth

When joints are swollen due to RA, it can sometimes produce an isolated area of redness on the skin. This is because the skins capillaries widen due to the inflammation within the joint capsule, making them more visible.

Additionally, when joints have become inflamed as a result of this disease, it is possible to feel warmth on the joint even if no redness is occurring. Thats why its important to pay attention to how your body feels as some RAs symptoms arent noticeable to the eye.

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What Imaging Techniques May Be Used To Diagnose Arthritis

Imaging techniques may give your healthcare provider a clearer picture of what is happening to your joint. Imaging techniques may include the following:

X-ray. X-rays may show joint changes and bone damage found in some types of arthritis. Other imaging tests may also be done.
Ultrasound. Ultrasound uses sound waves to see the quality of synovial tissue, tendons, ligaments, and bones.
Magnetic resonance imaging . MRI images are more detailed than X-rays. They may show damage to joints, including muscles, ligaments, and cartilage.
Arthroscopy. This procedure uses a thin tube containing a light and camera to look inside the joint. The arthroscope is inserted into the joint through a small incision. Images of the inside of the joint are projected onto a screen. It is used to evaluate any degenerative and/or arthritic changes in the joint to detect bone diseases and tumors to determine the cause of bone pain and inflammation, and to treat certain conditions.

The 2010 Acr/eular Classification Criteria Guidelines

How will Rheumatoid Arthritis start?

Sometimes people who have been diagnosed with RA take part in studies or clinical trials perhaps to try a promising drug or study ways to improve quality of life.

To identify RA patients with typical features of RA who are suitable for these important studies, scientists use a set of guidelines created by the American College of Rheumatology and the European League Against Rheumatism. These are called the 2010 ACR/EULAR classification criteria.

For classification purposes to be considered for enrollment into studies, patients must first have at least one inflamed joint that cant be explained by another condition. Then theyre evaluated for classification based on the following:

Joint involvement. Which joints are swollen? How many are affected? Are they large or small?
Serology test results. What are the results of RF and/or ACPA tests?
Acute-phase reactant test results. Are the results of CRP and/or ESR tests normal or abnormal?
Duration of symptoms. Have symptoms been around more or less than six weeks?

Others who may be eligible for studies include long-time RA patients whose past symptoms fulfill the criteria, those with joint damage very characteristic of RA, and those with new RA who are receiving treatment.

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Ra Diagnosis: What Criteria Are Used To Diagnose Rheumatoid Arthritis

If a patient is showing early signs and symptoms of RA, a doctor can refer the patient to a rheumatologist a physician who specializes in arthritis and other diseases of the joints, muscles and bones. The rheumatologist will work with the patient and the patients primary care physician to reach a RA diagnosis and provide treatment.

Because there is no exact known cause of RA, doctors look at a number of different factors before reaching a diagnosis. To reach a diagnosis, physicians follow a set procedure looking for multiple criteria, rather than one individual test. This includes examining physical symptoms, looking at family and personal medical history, and performing blood and other diagnostic tests .

Some cases may be easier to diagnose than others, especially in the early stages of developing symptoms when symptoms may be less clear. Doctors work hard to ensure theyve looked at all possibilities and that their examination and testing results are consistent with most cases of RA.

Learning That You Have A Chronic Life

Learning that you have a chronic, life-altering disease like arthritis is challenging news to swallow, no matter what kind of arthritis you may have, how old you are, or what your other personal circumstances are. But not everyone takes the news the same way and that may have a lot to do with the different ways people get diagnosed with arthritis.

Its not uncommon for people to have arthritis symptoms for years and in some cases, even decades before getting an accurate diagnosis and treatment plan. Misdiagnoses along the way are common. According to recent data from our ArthritisPower research registry presented at the 2018 European League Against Rheumatism annual meeting, 96 percent of people ultimately diagnosed with ankylosing spondylitis received at least one misdiagnosis nearly a third of respondents reported that it took more than 10 years to receive a formal diagnosisfrom when they began seeking medical attention. For 30 percent of people with psoriatic arthritis, it took more than five years to get diagnosed.

It doesnt help that for most kinds of arthritis, there are few definitive yes/no tests, and there are more than 100 different types of arthritis. While getting an arthritis diagnosis can often be relieving in some ways to have a name for your symptoms and an action plan for treatment, it can also leave you feeling like you still have more questions than answers.

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What Is The Difference

Rheumatoid arthritis vs. osteoarthritis

Rheumatoid arthritis and osteoarthritis are both common causes of pain and stiffness in joints. But they have different causes. In osteoarthritis, inflammation and injury break down your cartilage over time. In rheumatoid arthritis, your immune system attacks the lining of your joints.

Rheumatoid arthritis vs. gout

Rheumatoid arthritis and gout are both painful types of arthritis. Gout symptoms include intense pain, redness, stiffness, swelling and warmth in your big toe or other joints. In gout, uric acid crystals cause inflammation. In rheumatoid arthritis, its your immune system that causes joint damage.

Which Specialist Do I Need

While both rheumatologists and Southwest orthopedic specialists can treat joint-pain symptoms, it may be in the patients best interest to take a closer look at both options before deciding which specialist can best serve their needs. In cases where there is a family history of rheumatoid arthritis, for example, it would be perfectly logical and reasonable for a patient to seek out a consultation with a rheumatologist.

If, however, there is a family history of knee replacements and the patient is suffering from intractable knee pain, a better choice would be an Southwest orthopedic specialists. But how do you know which one makes the best sense for you?

Choosing a specialist does not mean you have made a permanent, unchangeable choice. If a patient seeking treatment from a rheumatologist does not improve with therapy, or as a patients condition progresses over time, there may be a need for some overlap in care from a rheumatologist to an orthopedic surgeon. In the beginning, however, the choice of which specialist to see will be primarily determined by the patients current and/or ongoing symptoms.

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What Increases Your Risk For Arthritis

Sometimes arthritis can occur with no known cause. But there are also factors that can increase your risk for all types of arthritis.

Age: Advanced age increases a persons risk for arthritis types such as gout, rheumatoid arthritis, and osteoarthritis.

Family history: You are more likely to have arthritis if your parent or sibling has an arthritis type.

Gender: Women are more likely to have RA than men while men are more likely to have gout.

Obesity: Excess weight can increase a persons risk for OA because it puts more pressure on the joints.

History of previous injuries: Those who have injured a joint from playing sports, from a car accident, or other occurrences are more likely to experience arthritis later.

Even if you dont feel the symptoms, you should discuss your potential risks for arthritis with your doctor. They can help provide ways to prevent or delay arthritis.

Just as the location of arthritis varies, not all people will have the same type of arthritis.

Your Lifestyle Is More Sedentary And Youre Moving Less

Regular physical activity is necessary for everyone but especially for people with RA. Research has shown that regular cardiovascular exercise and weight training can substantially improve daily function without exacerbating rheumatoid arthritis disease activity. There are numerous health benefits associated with regular physical activity like improved muscle strength and better bone and joint health which all help your aches and pains feel better. But rest is also needed to restore the body from the bouts of intense pain and fatigue that are characteristic of rheumatoid arthritis. But you cant let taking it easy become a way of life. A sedentary lifestyle may eventually lead to increased pain, fatigue, and weakness, and a lower quality of life.

Regular exercise also has another life-enhancing benefit: It helps reduce your odds of developing cardiovascular disease. Taking good care of your ticker is essential for people with rheumatoid arthritis, because heart problems are more prevalent in people who have RA compared with the general population. Its heart disease that kills you, not the RA, says Domingues. Its very important to talk to your primary care doctor or a cardiologist if you have RA to control your risk factors, such as high cholesterol, obesity, and diabetes.

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How Is Inflammatory Arthritis Treated

Inflammatory arthritis is usually treated with a combination of medications that relieve swelling and pain along with others, such as steroids or immunosuppressive drugs, that regulate the immune system. To prevent loss of mobility and joint function, it is essential that patients strive to balance between periods of rest and activity .

As with osteoarthritis, joint replacement surgery may need to be considered when these nonsurgical methods have failed to provide lasting benefit.

Learn more about IA from the articles below or find the best arthritis doctor at HSS for your condition and insurance by selecting treating physicians.

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How Is Ra Treated

Arthritis: Signs and When to See a Doctor

RA can be effectively treated and managed with medication and self-management strategies. Treatment for RA usually includes the use of medications that slow disease and prevent joint deformity, called disease-modifying antirheumatic drugs biological response modifiers are medications that are an effective second-line treatment. In addition to medications, people can manage their RA with self-management strategies proven to reduce pain and disability, allowing them to pursue the activities important to them. People with RA can relieve pain and improve joint function by learning to use five simple and effective arthritis management strategies.

What Causes Rheumatoid Arthritis

The exact cause of rheumatoid arthritis is unknown. Researchers think its caused by a combination of genetics, hormones and environmental factors.

Normally, your immune system protects your body from disease. With rheumatoid arthritis, something triggers your immune system to attack your joints. An infection, smoking or physical or emotional stress may be triggering.

Is rheumatoid arthritis genetic?

Scientists have studied many genes as potential risk factors for RA. Certain genetic variations and non-genetic factors contribute to your risk of developing rheumatoid arthritis. Non-genetic factors include sex and exposure to irritants and pollutants.

People born with variations in the human leukocyte antigen genes are more likely to develop rheumatoid arthritis. HLA genes help your immune system tell the difference between proteins your body makes and proteins from invaders like viruses and bacteria.

How Is Arthritis Diagnosed

Seeing your primary care physician is a good first step if youre unsure who to see for an arthritis diagnosis. They will perform a physical exam to check for fluid around the joints, warm or red joints, and document the range of motion in the joints. Your doctor can refer you to a specialist if needed.

If youre experiencing severe symptoms, you may choose to schedule an appointment with a rheumatologist first. This may lead to a faster diagnosis and treatment.

Documenting inflammation levels in your blood and aspirating and analyzing joint fluids, if present, can help your doctor determine what kind of arthritis you have.

Blood tests that check for specific types of antibodies like anti-cyclic citrullinated peptide , rheumatoid factor and antinuclear antibody are also common diagnostic tests.

Doctors commonly use imaging scans such as X-ray, MRI, and CT scans to produce an image of your bones and cartilage. This helps them rule out other causes of your symptoms, such as bone spurs.

The main goal of treatment is to reduce the amount of pain youre experiencing and prevent additional damage to the joints. Youll learn what works best for you in terms of managing pain.

In general, treatment for arthritis

heat and cold compresses
mobility assistance devices, such as canes or walkers

Improving your joint function is also important. Your doctor may prescribe a combination of treatment methods to achieve the best results.

How Do Doctors Diagnose Rheumatoid Arthritis