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How Do Doctors Test For Arthritis

What Are The Symptoms Of Rheumatoid Arthritis

Ask The Rheumatologist: Which Tests Should You Do to Diagnose Rheumatoid Arthritis?

The symptoms of rheumatoid arthritis include the following:

  • Stiffness, especially in the morning or after sitting for long periods

Rheumatoid arthritis affects each person differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may proceed rapidly. A few people may have rheumatoid arthritis for a limited period of time and then go into remission .

Cartilage normally acts as a shock absorber between the joints. Uncontrolled inflammation causes the destruction and wearing down of the cartilage, which leads to joint deformities. Eventually, the bone itself erodes, potentially leading to fusion of the joint . This process is aided by specific cells and substances of the immune system, which are produced in the joints but also circulate and cause symptoms throughout the body.

How Is Arthritis Diagnosed

If you think you may have arthritis, see your healthcare provider. The provider will ask about your symptoms and learn how joint pain affects your life. Your provider will perform a physical exam, which may include:

  • Assessing mobility and range of motion in your joints.
  • Checking for areas of tenderness or swelling around your joints.
  • Evaluating your overall health to determine if a different condition could be causing your symptoms.

What Are The Risk Factors For Arthritis

Some factors make you more likely to develop arthritis, including:

  • Age: The risk of arthritis increases as you get older.
  • Lifestyle: Smoking or a lack of exercise can increase your risk of arthritis.
  • Sex: Most types of arthritis are more common in women.
  • Weight: Obesity puts extra strain on your joints, which can lead to arthritis.

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Sedimentation Rate Blood Test

Like RF and anti-CCP tests, erythrocyte sedimentation rate blood tests can be used to assess the inflammatory activity in a persons body and confirm the presence of certain autoimmune conditions.

During this test, your blood sample will be poured into a long, thin tube. Over the course of an hour, the red blood cells in the sample will gradually descend to the bottom of the tube. However, samples from people with inflammation, cells tend to fall faster. This is because inflammation often causes blood cells to clump. At the end of the hour, lab technicians will measure the descent of the blood cells. The further the cells have fallen, the more suggestive the test is of an autoimmune condition.

According to the Mayo Clinic, a healthy sedimentation rate generally ranges from 0 to 22 mm/hour for males and 0 to 29 mm/hour for females. Around 40 percent of people with psoriatic arthritis exhibit elevated ESR rates. That said, a high ESR is very non-specific and can be caused by a wide variety of different conditions including RA, giant cell arteritis, polymyalgia rheumatica, and many others.

It is also important to note that some unrelated factors such as older age, pregnancy, kidney problems, cancer, infection, anemia, and thyroid disease can skew a persons ESR results. Doctors will likely ask you if you have any conditions that could interfere with the test before ordering it and analyzing your results.

What Is Rheumatoid Arthritis

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Arthritis is a general term for inflammation in joints. Rheumatoid arthritis is a type of chronic arthritis that occurs in joints on both sides of the body , which helps distinguish it from other types of arthritis.

In addition to affecting the joints, rheumatoid arthritis may occasionally affect other parts of the body, including the skin, eyes, lungs, heart, blood, nerves, or kidneys.

Rheumatoid arthritis is an autoimmune disease, meaning that patients immune system is overreacting against itself. The result can cause some or all of the symptoms of rheumatoid arthritis.

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Do Certain Types Of Weather Make Arthritis Worse

Some people find that arthritis feels worse during certain types of weather. Humidity and cold are two common triggers of joint pain.

There are a variety of reasons why this might happen. People tend to be less active in rainy seasons and the wintertime. The cold and damp can also stiffen joints and aggravate arthritis. Other theories suggest that barometric pressure, or the pressure of the air around us, may have some effect on arthritis.

If you find that certain types of weather make your arthritis worse, talk to your healthcare provider about ways to manage your symptoms. Dressing warmly, exercising inside or using heat therapy may help relieve your pain.

A note from Cleveland Clinic

Arthritis is a disease that affects the joints. There are many types of arthritis, all of which can cause pain and reduce mobility. Some forms of arthritis result from natural wear and tear. Other types come from autoimmune diseases or inflammatory conditions. There are a variety of treatments for arthritis, ranging from physical or occupational therapy to joint surgery. Your healthcare provider will assess your symptoms and recommend the right treatment plan for your needs. Most people can successfully manage arthritis and still do the activities they care about.

Last reviewed by a Cleveland Clinic medical professional on 04/15/2021.

References

Will I Need Surgery For Arthritis

Healthcare providers usually only recommend surgery for certain severe cases of arthritis. These are cases that havent improved with conservative treatments. Surgical options include:

  • Fusion: Two or more bones are permanently fused together. Fusion immobilizes a joint and reduces pain caused by movement.
  • Joint replacement: A damaged, arthritic joint gets replaced with an artificial joint. Joint replacement preserves joint function and movement. Examples include ankle replacement, hip replacement, knee replacement and shoulder replacement.

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How Does A Normal Joint Work

A joint is where two bones meet. Most of our joints are designed to allow the bones to move in certain directions and within certain limits.

For example, the knee is the largest joint in the body and one of the most complicated. It must be strong enough to take our weight and must lock into position, so we can stand upright.

It also has to act as a hinge, so we can walk, and needs to twist and turn when we run or play sports.

The end of each bone is covered with cartilage that has a very smooth, slippery surface. The cartilage allows the ends of the bones to move against each other, almost without rubbing.

The joint is held in place by the synovium, which contains thick fluid to protect the bones and joint.

The synovium has a tough outer layer that holds the joint in place and stops the bones moving too far.

Strong cords called tendons anchor the muscles to the bones.

What If Everything Comes Back Normal

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Often patients with PsA will have normal CRP and ESR levels. Similarly, while anti-CCP is typically an RA indicator, anti-CCP can be both negative or positive in PsA.

While bloodwork is certainly part of the diagnostic process, patient history and a physical examination are the most important factors to correctly diagnose PsA.4,9

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Erythrocyte Sedimentation Rate Test

An erythrocyte sedimentation rate test evaluates how much inflammation is present in your body. The test measures how quickly your red blood cells, called erythrocytes, separate from your other blood cells in a lab when they are treated with a substance that prevents clotting.

Red blood cells clump together when theres inflammation in your body, making them separate from your other blood cells much faster. Low ESR levels indicate low levels of inflammation while high ESR results indicate high levels of inflammation.

Doctors use this test to diagnose rheumatoid arthritis because this condition causes inflammation throughout your body. An ESR test on its own, however, is not enough to diagnose rheumatoid arthritis.

Inflammation and a rise in ESR levels can be caused by other chronic conditions, and by infections or injuries. However, your ESR rate can help point doctors in the right direction. For example, very elevated ESR levels would likely indicate an infection and not rheumatoid arthritis.

Reviewing Your Risk Factors

Your doctor may suspect you’re dealing with rheumatoid arthritis if youre a woman because about 75% of people who are diagnosed with RA are female. Some women are diagnosed with RA early, in their 20s or 30s, but a number are diagnosed later, in their 50s or 60s. Men who are diagnosed tend to be older. If you have first-degree family members who have been diagnosed with RA, tell your doctor, because that increases your risk as well.

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What Imaging Tests Are Used In The Diagnosis Of Psoriatic Arthritis

The following imaging tests are used:

  • X-rays. Plain X-rays of the affected joints may show changes that are typically found in psoriatic arthritis.
  • Magnetic resonance imaging . An MRI uses radio waves and strong magnetic fields that give a detailed view of joints, ligaments and tendons in the body.
  • Bone mineral density or BMD test . Psoriatic arthritis and the medications used to treat the condition can cause an increased loss of bone. Your doctor may order this test to know the extent of bone loss. The result indicates your risk of fractures.

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How To Test For Arthritis In A Physical Exam

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After these initial conversations, the next step in conducting a test for arthritis is a physical exam.2 Doctors will touch the affected joints to check for swelling, redness, and stiffness. It is also common for doctors to make a joint count of how many joints are affected and whether they are on one or both sides of the body. Joint warmth and fluid can often also be felt during a physical exam of an arthritis patient. In addition to a joint assessment, doctors will commonly also take a patients temperature, look into the eyes, nose, ears, and throat, and check for reflexes and swollen glands.

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Diagnosis Of Psoriatic Arthritis

Although there is no definitive test for psoriatic arthritis, your doctor may do the following to diagnose you with the condition:

  • Ask if you have a family history of psoriasis or psoriatic arthritis.
  • Talk to you about your symptoms and give you a physical exam. Swollen and tender joints, psoriasis skin lesions, and nail changes are telltale signs.
  • Examine your skin for signs of psoriasis, if you have never been diagnosed with the condition.
  • Take a blood sample to check for other conditions, such as rheumatoid arthritis.
  • Order imaging tests such as x-rays, ultrasounds, or magnetic resonance imaging , which can reveal changes in joints, entheses, or the spine.

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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 the 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 xrays. 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.

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Whats The Outlook For Someone Living With Arthritis

Since theres no cure for arthritis, most people need to manage arthritis for the rest of their lives. Your healthcare provider can help you find the right combination of treatments to reduce symptoms. One of the biggest health risks associated with arthritis is inactivity. If you become sedentary from joint pain, you may face a greater risk for cancer, heart disease, diabetes and other serious conditions.

Types Of Arthritis Tests

Arthritis: Signs and When to See a Doctor

Diagnosing arthritis involves taking a patients medical history, conducting a physical examination, and performing imaging and blood tests. Testing of joint fluid is often needed. Because there are many types of arthritis, its important for doctors to identify the type of arthritis causing a patients symptoms.

After taking a patients medical history and conducting a physical exam, doctors may recommend a synovial fluid analysis. Synovial fluid is located in the spaces between joints and cushions bone ends to reduce friction during movement of the joint. The synovial fluid analysis consists of a group of tests that determine the underlying cause of arthritis. For example, the presence of needle-shaped uric acid crystals helps confirm gouty arthritis.

Additional tests may be used to diagnose arthritis and rule out other conditions. The selection of tests depend on a patients symptoms and the type of arthritis suspected by doctors.

Several tests may be performed to determine whether a patients symptoms are related to inflammation, including from infectious or other systemic disorders. However, these tests are not able to identify the specific underlying cause:

Tests Related to Diagnosing Inflammatory Disorders
Test Name
Blood sample A protein that increases due to inflammation in the body

Additional tests may be ordered to diagnose or rule out autoimmune rheumatic disorders, including rheumatoid arthritis and ankylosing spondylitis:

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Rheumatoid Arthritis Blood Tests

The rheumatoid arthritis blood tests that doctors perform to help diagnose the disease include:

  • Rheumatoid factor
  • C-Reactive Protein
  • Antinuclear Antibody

None of these tests can singularly conclude that a patient has rheumatoid arthritis. Rather, doctors look at the combined results from all, alongside a number of other criteria including physical symptoms and genetics, in order to reach a rheumatoid arthritis diagnosis.

Conditions That Can Mimic Ra

Another reason RA may be tough to diagnose in early stages is that some initial signs and symptoms can be difficult to distinguish from other conditions. Viral infections, other kinds of arthritis, and other autoimmune diseases may all be mistaken for RA, depending on which specific constellation of symptoms you have. Its important to learn about these different diseases so you can be sure to be as specific as possible when describing your medical history to your doctor.

Some of the conditions that mimic rheumatoid arthritis include:

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The Role Of Arthritis Testing

Arthritis testing may be used for diagnosis, guiding treatment, or monitoring of arthritis:

  • Diagnosis: Arthritis testing is often used to diagnose the cause of a persons symptoms and rule out other health conditions.
  • Treatment planning: In some patients, arthritis testing is used to plan for treatment or determine a patients risk of severe side effects while receiving arthritis treatment.
  • Monitoring: While patients are being treated for arthritis, testing may be used to monitor the effectiveness of medications and track the progression of the disease.

How Is Arthritis Treated

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The goal of treatment is to provide pain relief, increase joint mobility and strength, and control the disease as much as possible. Your doctor has a number of options to help you manage pain, prevent damage to the joint, and keep inflammation at bay.

Treatment of arthritis could include rest, occupational or physical therapy, hot or cold compresses, joint protection, exercise, drugs, and sometimes surgery to correct joint damage. Your treatment plan may involve more than one of these.

Treatments for osteoarthritis generally can help relieve pain and stiffness, but the disease may continue to get worse. The same was true for rheumatoid arthritis in the past, but treatments are now able to slow or stop the progression of arthritis damage.

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The 2010 Acr/eular Classification Criteria Guidelines

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.

Ra Imaging Tests: What Tests Are Done For Rheumatoid Arthritis

Rheumatoid arthritis imaging tests are used to look for signs of RA and to monitor the diseases progression. These tests primarily look for bone damage in the patients joints caused by the inflammation associated with RA.

X-rays used to be the most common form of imaging ordered, but they werent always great for reaching an early diagnosis. Todays more modern technology provides advanced imaging techniques like MRIs and ultrasounds, which allow doctors to find early signs of RA more easily.

All types of imaging tests are a critical component of diagnosing RA and monitoring the patients disease as it develops over time. Imaging tests provide doctors with a literal picture of the patients progression so that they can pursue appropriate treatment options.

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