What Else Could It Be
When a doctor thinks about how likely you are to have one disease over another, or over several others, this is called a differential diagnosis. There are many conditions your doctor may consider besides RA, and besides other forms of autoimmune arthritis:
Polymyalgia rheumatica: This is more common over age 50, generally less painful than RA, and associated more with shoulders and hips.
How Does It Affect Your Body
Immune system cells move from the blood into your joints and the tissue that lines them. This is called the synovium. Once the cells arrive, they create inflammation. This makes your joint swell as fluid builds up inside it. Your joints become painful, swollen, and warm to the touch.
Over time, the inflammation wears down the cartilage, a cushy layer of tissue that covers the ends of your bones. As you lose cartilage, the space between your bones narrows. As time goes on, they could rub against each other or move out of place. The cells that cause inflammation also make substances that damage your bones.
Exercise And Physical Therapy
Results of randomized controlled trials support physical exercise to improve quality of life and muscle strength in patients with RA.32,33 Exercise training programs have not been shown to have deleterious effects on RA disease activity, pain scores, or radiographic joint damage.34 Tai chi has been shown to improve ankle range of motion in persons with RA, although randomized trials are limited.35 Randomized controlled trials of Iyengar yoga in young adults with RA are underway.36
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When To See A Healthcare Provider
Rheumatoid arthritis can be scary, and not only because of the symptoms but because of the uncertainty of what lies ahead. Don’t let this stop you from taking action if you suspect you have the disease.
The advantage of an early diagnosis is that it allows you early treatment. Simply put, the sooner you take disease-modifying medications, the better your long-term outlook is.
This is especially true if you have a family history of rheumatoid arthritis. Having a sibling or parent with rheumatoid arthritis nearly triples your risk of the disease, while having a second-degree relative doubles your risk.
Possible RA symptoms that warrant a trip to the healthcare provider include:
- Pain, swelling, or stiffness in one or more joints
- Joints that are red or warm to the touch
- Regular joint stiffness in the morning
- Difficulty moving a joint or doing daily activities
- An episode of increased joint pain and stiffness lasting for more than three days
Reaching A Ra Diagnosis
Once all of these steps have been conducted, doctors will look at all of the test results and reach a conclusion based on the overall picture. Some doctors take a more symptom based approach to diagnosing RA while others rely on blood tests and medical history to confirm a RA diagnosis.
This is why its possible to be diagnosed with RA but not test positive for antibodies or have a medical history of RA in your family. If the symptoms themselves are consistent with RA, then it can still be diagnosed.
That being said, the main criteria for diagnosing RA do not change. The patient must exhibit symptoms for greater than six weeks, symmetrical symptoms, as well as multiple joints being affected including fingers and hands.
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How To Prepare For An Initial Doctors Appointment
During your first appointment, your doctor will conduct a physical exam, collect details about your medical history, and discuss which symptoms you may be experiencing.
Generally, they will evaluate your joints for inflammation, swelling, and redness and may order imaging tests or blood work to determine if you have RA.
Be sure to keep track of all your symptoms and consider logging the time, duration, and severity of each symptom as it occurs. You should also provide your doctor with information about any medications that you are taking, including the frequency and dosage.
Keep in mind that you may not receive a definitive diagnosis on your first visit, as many autoimmune disorders develop slowly over time.
However, your doctor may discuss possible treatment options with you, which can include medications, physical therapy, pain management, exercise, and other modifications to your diet and lifestyle.
Its important to discuss any questions you have regarding your treatment plan with your doctor. Some questions you may want to consider asking:
- What treatment options are right for me?
- What are the potential side effects from my treatment?
- What types of exercise would be beneficial? How often should I work out?
- Are there other ways to treat symptoms at home, such as by using a hot or cold compress?
- What options available for mental health support, if needed?
- Would I benefit from physical therapy, nutrition counseling, or other complementary treatments?
What Is Rheumatoid Arthritis
Similar to other autoimmune conditions, rheumatoid arthritis causes your immune system to attack the healthy tissues and cells in your body. Although RA usually damages the joints, it can affect other parts of the body, such as the eyes, heart, or lungs. RA can cause inflammation in joints located in the wrists, hands, knees, and ankles.
Symptoms can vary from person to person, but some early signs of RA include pain and tenderness in the joints. Over time, symptoms may get worse and progress to redness, stiffness, and swelling in the joints. Some people also have a low-grade fever and fatigue.
The exact cause of RA is not known, but several factors increase the risk of having this disease. It occurs more often in older adults and women. Smoking and being overweight also raise the risk of having RA. Certain genes have been linked to a higher chance of developing RA.
Illustration by Verywell
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Diagnosis And Management Of Rheumatoid Arthritis
AMY M. WASSERMAN, MD, Boston University School of Medicine, Boston, Massachusetts
Am Fam Physician. 2011 Dec 1 84:1245-1252.
Patient information: A handout on this topic is available at .
Rheumatoid arthritis is the most common inflammatory arthritis, with a lifetime prevalence of up to 1 percent worldwide.1 Onset can occur at any age, but peaks between 30 and 50 years.2 Disability is common and significant. In a large U.S. cohort, 35 percent of patients with RA had work disability after 10 years.3
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Patients with inflammatory joint disease should be referred to a rheumatology subspecialist, especially if symptoms last more than six weeks.
|Clinical recommendation||Evidence rating||References|
In persons with RA, combination therapy with two or more disease-modifying antirheumatic drugs is more effective than monotherapy. However, more than one biologic agent should not be used at one time because of the high risk of adverse effects.
A guided exercise program can improve quality of life and muscle strength in patients with RA.
Cardiovascular disease is the main cause of mortality in persons with RA therefore, risk factors for coronary artery disease should be addressed in these patients.
RA = rheumatoid arthritis.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
RA = rheumatoid arthritis.
Your Injuries Seem To Take A Long Time To Heal
Its possible to think you have an injurysuch as a sprained ankle that doesnt seem to healwhen the symptoms are actually due to RA.
This is more common in younger people, says Lisa A. Mandl, MD, MPH, assistant attending rheumatologist at Hospital for Special Surgery in New York City.
One day a patient is playing soccer and the next day her knee is swollen, she says. “I have seen people who have had two arthroscopic surgeries and extensive physical therapy in their knee and they have rheumatoid arthritis.”
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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.
Causes Of Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease. This means your immune system attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful.
Over time, this can damage the joints, cartilage and nearby bone.
It’s not clear what triggers this problem with the immune system, although you’re at an increased risk if:
- you are a woman
Find out more about the causes of rheumatoid arthritis.
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Your Joints And Rheumatoid Arthritis
Joints are places where bones meet. Bones, muscles, ligaments and tendons all work together so that you can bend, twist, stretch and move about.
The ends of your bones are covered in a thin layer of cartilage. It acts like a slippery cushion absorbing shock and helping your joint move smoothly.
The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid lubricates and nourishes the cartilage and other structures in the joint.
When you have rheumatoid arthritis:
- your immune system attacks your joints, which causes:
- a build-up of synovial fluid
- inflammation of the tissues that line the joint
- pain, heat and swelling
When Should I See A Specialist For Rheumatoid Arthritis
In general, patients with RA will benefit from seeing a specialist as early as possible. Most often the specialists treating this disease are trained in rheumatology. Their knowledge of medications to treat this disease can help patients make informed decisions consistent with their values and goals. These specialists can also help provide a balanced perspective on the benefits of treating the disease well vs. any potential side effects.
Patients diagnosed with RA are encouraged to become the captain of their multidisciplinary team of health providers. These include the primary care physician, the rheumatologist, the physical therapist, social worker, education programs and other members of the health care system will bring about a coordinated treatment program that is both safe and effective. The primary care physician or internist commonly works in partnership with a rheumatologist. Referral to a specialist in rheumatology most commonly occurs in the following situations:
- when the diagnosis is in question
- at the start of therapy, in order to provide expert input into the optimal medication and physical therapy regimen
- during the course of the illness to define response to or alteration in the treatment regimen
- in the setting of possible medication side effects
- progressive disease despite therapy
- a single joint that is leading to significant functional limitation
- the presence of fever, marked fatigue, or weight loss
- prior to orthopedic surgery
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Living With Rheumatoid Arthritis
You can do several things to help you learn about RA, take care of yourself, and keep a positive outlook.
- Rest and exercise. Get more rest when your RA is active and more exercise when it is not. Rest helps to lower joint swelling, pain, and fatigue. Exercise is important for keeping strong muscles, helping your joints move, and staying flexible. Doctors usually recommend low-impact exercises, such as water exercise programs. Talk to your health care providers before starting any exercise program.
- Joint care. Some people wear a splint for a short time to reduce pain and swelling. 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 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.
- Staying at a healthy weight to help lower the stress on your joints.
General Joint Pain And Stiffness
In addition to morning joint stiffness, you may also experience general joint stiffness throughout the day, especially after a period of inactivity.
Some of the first areas RA stiffness typically affects are the wrists and certain joints in the hands and feet, but its also possible to experience pain and stiffness in your knees or shoulders. Usually, both sides of your body will be affected.
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Rheumatoid Arthritis: Blood Tests For Diagnosis
Rheumatoid arthritis is an autoimmune condition that mostly affects the joints. Obtaining an RA diagnosis can feel like putting together a puzzle because this disease has symptoms that are similar to other disorders. In addition to checking your medical history and doing a physical exam, your healthcare provider may order multiple tests before diagnosing RA.
There is not a test for RA that can definitively diagnose this condition, so you may have several imaging and blood tests. The blood tests can show if your body has inflammation and is making specific proteins that are common when you have RA.
The blood tests may include:
- Rheumatoid factor
Verywell / Joshua Seong
Points To Remember About Rheumatoid Arthritis
- Rheumatoid arthritis is a chronic disease that mostly causes pain, swelling, stiffness, and loss of function in joints.
- RA may cause you to feel unusually tired, to have occasional fevers, and to have a loss of appetite.
- Treatments can include medications, ongoing care from a doctor, and surgery.
- The goals of treatment are to help relieve pain and swelling, prevent, slow, or stop joint and organ damage, and help you take part in daily activities.
- You can do many things to help you cope with RA, including finding a balance between rest and exercise, keeping a healthy weight, taking care of your joints, talking with your doctors, family, and friends, and managing your stress.
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What Are The Risk Factors For Ra
Researchers have studied a number of genetic and environmental factors to determine if they change persons risk of developing RA.
Characteristics that increase risk
- Age. RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
- Sex. New cases of RA are typically two-to-three times higher in women than men.
- Genetics/inherited traits. People born with specific genes are more likely to develop RA. These genes, called HLA class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
- Smoking. Multiple studies show that cigarette smoking increases a persons risk of developing RA and can make the disease worse.
- History of live births. Women who have never given birth may be at greater risk of developing RA.
- Early Life Exposures. Some early life exposures may increase risk of developing RA in adulthood. For example, one study found that children whose mothers smoked had double the risk of developing RA as adults. Children of lower income parents are at increased risk of developing RA as adults.
- Obesity. Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.
Characteristics that can decrease risk
Can You Have Ra For Years And Not Know It
In a few people with RA about 5% to 10% the disease starts suddenly, and then they have no symptoms for many years, even decades. Symptoms that come and go. This happens to about 15% of people with rheumatoid arthritis. You may have periods of few or no problems that can last months between flare-ups.
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Lab And Blood Tests For Ra
Here are some of the things you can expect to happen at your appointment if the doctor thinks you have RA.
Personal and family medical history: Your doctor will ask about your past and your relativesâ. If someone in your family tree has RA, you may be more likely to have the disease.
Physical exam: The doctor will check your joints for swelling, tenderness, and range of motion. RA tends to strike several joints.
Antibody blood tests: Doctors look for certain proteins that show up in your blood when you have RA. These proteins mistakenly target healthy cells and kick off the inflammation process. So a high or positive test result means inflammation is in your body.
- Rheumatoid factor : high levels
- Anti-CCP : high levels
- ANA, or antinuclear antibodies: the results are positive or negative
Not all people with RA have these proteins.
Other blood tests: Besides RF and anti-CCP, other blood tests could include:
Complete blood count: It helps your doctor find anemia , which is common in RA. It looks for four things:
- White blood cells 4.8-10.8
- Hematocrit 42-52
- Platelets 150-450
Erythrocyte sedimentation rate: This measures how fast your red blood cells clump and fall to the bottom of a glass tube within an hour. Your doctor might call it a sed rate.
Normal ranges are:
- Men younger than 50: 0-15 mm/h
- Men older than 50: 0-20 mm/h
- Women younger than 50: 0-20 mm/h
- Women older than 50: 0-30 mm/h