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.
Tests That Help Diagnose Ra
To help confirm or disprove RA, your rheumatologist will also have lab tests done. The lab tests would point to likelihood of rheumatoid arthritis, as well as potentially rule out other possibilities on the differential diagnosis, says Dr. Neogi. These tests may include:
Erythrocyte sedimentation rate and C-reactive protein blood tests detect and measure inflammation in your body. If inflammation levels are elevated, it helps build the case for an RA diagnosis. If inflammation levels are normal, says Dr. Neogi, That might dissuade us from thinking about an inflammatory arthritis like rheumatoid arthritis, but would not rule it out. Since inflammation is present in many diseases, these tests do not confirm whether you have RA by themselves.
Rheumatoid factor and anti-cyclic citrullinated peptide antibody blood tests look for proteins associated with RA. Testing positive for one increases your chances of RA diagnosis, while testing positive for both raises your odds even more. However, up to 50 percent of RA patients dont have RF or anti-CCP antibodies. They are diagnosed based on other factors. In these cases, the RA is considered to be seronegative.
The possibility of some autoimmune disorders, such as lupus and Sjögrens syndrome, can be eliminated with the help of an antinuclear antibody blood test, while a synovial fluid analysis, which examines the fluid that lubricates your joints, can help count out gout by looking for crystals under the microscope.
How Is It Diagnosed
Your doctor will diagnose RA from your symptoms, a physical examination and various tests. These can include:
- blood tests for inflammation
- blood tests for antibodies . Testing for anti-cyclic citrullinated peptide and rheumatoid factor can help diagnose RA, although not all people with RA will test positive for these antibodies. See the Blood tests information sheet.
- x-rays to see if your joints are being damaged by the disease. X-ray changes are rare in the early stages of RA.
It can be difficult, and often takes time, to diagnose RA as the symptoms can be similar to other types of arthritis. If your doctor suspects you have RA you should be referred to a rheumatologist, a doctor who specialises in arthritis.
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How Likely Is Rheumatoid Arthritis To Affect Your Knees
As a major joint in your body, it is quite likely that, once diagnosed with RA, you will develop rheumatoid arthritis in the knee at some point. It isnt usually the first joint to be attacked that is normally taken by your hands or feet. However, given the significance to you of your knees for your overall mobility, looking after them is no less important.
Expert Q& a: How Often Do I Need Blood Tests With Methotrexate
Learn why frequent blood tests are necessary when taking methotrexate.
Question: I have been taking 15 mg of methotrexate weekly for the past seven years. I have had blood work done at least every other month during that time however, my doctor wants me to have blood tests every month. Since none of my past blood tests have shown any problems, I am wondering why I need to have these tests so often. Wouldn’t every few months suffice?
Answer: No, I wouldn’t recommend having those tests any less frequently than your doctor recommends. In general, patients taking methotrexate should have the tests monthly. Just because you haven’t had any problems for the past seven years doesn’t mean you can’t develop problems at any time in the future.
Methotrexate can cause liver or kidney problems. Frequent blood tests may detect subtle abnormalities that could alert your doctor to modify your methotrexate dose before a serious problem occurs. If you still have concerns about the frequency of your lab tests, I would recommend bringing up the subject with your doctor at your next appointment. In the meantime, I know it’s a hassle to have the tests monthly, but in doing so, you may save yourself serious problems down the road.
Bernard Rubin, DO
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Question 4 Of : Treatment
How Ra Affects Feet
Rheumatoid arthritis is an autoimmune condition. When you have RA, your immune system tries to destroy the lining of your joints, called synovium. It also attacks the fluid in your joints, called synovial fluid. It does this because it mistakes these parts of your body for disease-causing invaders.
RA causes damage and inflammation that makes your joints swell and feel warm. The small joints, like those in the feet, are the most common targets of these attacks.
Eventually, long-term inflammation thickens the synovium. This causes cartilage and bone to wear away. In the feet and toes, the joints may become deformed. This leads to poor range of motion and considerable pain. Walking, standing, and even wearing shoes can become difficult.
Proper treatment may help reduce the damage and inflammation to your foot joints. It may also prevent or delay deformities and other problems.
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S To Diagnosing Rheumatoid Arthritis
If youre addressing chronically inflamed, aching joints, youre not alone. rheumatoid arthritis affects 1.3 million Americansbut its surprisingly multifaceted and not always simple to diagnose. If joint pain and stiffness cause you to wonder if you may have this disease, its smart to speak along with your doc. the earlier you get a handle on RA symptoms through proper treatment, the simpler its to stop long-term joint damage. Follow along, as we rehearse the diagnosis process.
Theyll Get You On A Treatment Plan
Although there is no cure for rheumatoid arthritis, Medicine and treatment for RA have advanced a lot over the past few years, and we can likely prevent or stop the progression, says Dr. Cohen. Doctors typically prescribe disease-modifying antirheumatic drugs , which can alleviate symptoms and slow RA down. Sometimes, people are also prescribed nonsteroidal anti-inflammatory drugs or corticosteroids to help with pain and inflammation. And some patients receive biologics, which help prevent inflammation and joint damage in more serious cases. Youve got lots of options!
RA and Imaging: National Institute of Arthritis and Musculoskeletal and Skin Diseases. . Diagnosis of Rheumatoid Arthritis. niams.nih.gov/health-topics/rheumatoid-arthritis/advanced#tab-diagnosis
RA and Risk Factors: Arthritis Foundation. . What Is Rheumatoid Arthritis? arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php
RA and Treatments: American College of Rheumatology. . Rheumatoid Arthritis. rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis
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Is It Ra Or Osteoarthritis
When you first notice foot pain, you may wonder if it’s osteoarthritis . OA is also known as wear-and-tear arthritis, and it is more common than rheumatoid arthritis.
There is no clear-cut way to tell if you have OA or RA without a medical diagnosis. But OA and RA do have some key differences.
Usually affects both feet at once
Morning stiffness generally lasts longer than half an hour
Most often affects only one foot
Stiffness tends to be easier to relieve in the morning, often getting better in less than half an hour or with a few minutes of stretching
How Is Rheumatoid Arthritis Diagnosed
RA can be difficult to diagnose because many conditions cause joint stiffness and inflammation. Your doctor will do a physical examination, checking your joints to see if they are swollen and to find out how easily they move. It is important to tell your doctor about all of your symptoms, not just the ones you think are important.
If your doctor thinks you have RA, they should refer you to a specialist called a ‘rheumatologist’. A rheumatologist can diagnose this disease and ensure you receive the right treatment. If you have RA and have not yet seen a rheumatologist, you can ask your doctor for a referral.
Your doctor may carry out a series of tests, which may help to confirm the diagnosis, or they may refer you at the same time as requesting tests. Tests that you may have are outlined below.
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Pay Attention To Your Symptoms
People of all ages can develop symptoms of RA. Patients ahead of time may have swelling of the finger joints, wrist joints, or knees, explains Jonathan Samuels, M.D., a rheumatologist at NYU Langone Health in NY City. They may additionally have stiffness within the mornings, or difficulty using and opening jars, doorknobs, making a fist, or shaking hands. Your symptoms could also be mild initially, then attain more serious inflammation and pain over a period of weeks or months.
What Are The Symptoms Of Rheumatoid Arthritis
The symptoms of RA usually develop gradually. The first symptoms are often felt in small joints, such as your fingers and toes, although shoulders and knees can be affected early, and muscle stiffness can be a prominent early feature.
- Flare-ups: The symptoms of RA vary from person to person. They can come and go, and they may change over time. You will experience flare-ups when your symptoms will be more intense and severe.
- Pain: This is usually a throbbing and aching sort of pain. It is usually worse in the mornings and after you have been sitting still for a while.
- Stiffness: Joints affected by RA can feel stiff, especially in the morning.
- Warmth and redness: The lining of the affected joint becomes inflamed, causing the joints to swell, become hot, tender to touch and painful.
RA can also cause inflammation around the joints.
You might also experience:
- dry eyes
- chest pain
If you think you may have the symptoms of RA, its important to see a doctor because early diagnosis and correct treatment can reduce the impact of the disease. If left untreated, RA may permanently damage joints.
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Diagnosis Of Rheumatoid Arthritis In The Knee
Diagnosis of rheumatoid arthritis is fairly standard a full medical check to establish functional capability and any new restrictions. This will then typically be followed by a full physical examination for deformities, nodules and other potential symptoms followed by blood tests to determine if rheumatoid factor is present.
The doctor may then also a series of x-rays, CT scans, MRI scans and maybe even a bone scan to determine how far your arthritis has progressed.
It is also likely that you will be referred to a rheumatologist within 3 months. While there is no cure for rheumatoid arthritis, the sooner treatment is started the better the eventual outcome is likely to be.
How Do You Know If You Have Ra
Because rheumatoid arthritis can occur at any age, its important to know the symptoms. RA typically starts in smaller joints, such as the hands, wrists, elbows, feet, and toes. However, it can spread to your larger joints. Symptoms of RA are:
- Painful swelling in your joints
- Fatigue after activity
- Joint deformity
- Fever and weight loss
One noticeable trait of RA is that it often occurs on symmetrical parts of your body.
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Rheumatoid Arthritis Initial Diagnosis
There is no single test that can definitively diagnose RA.
As with other illnesses, diagnosis of RA typically begins with your doctor getting your medical history and conducting a physical exam.
You doctor will begin by asking questions about the symptoms you’re experiencing, including when and how they occur and how they’ve changed over time . One specific symptom they will ask about is morning joint stiffness that lasts for at least 30 minutes and occurs in the peripheral joints rather than the lower back a common RA symptom.
The other main symptom is swelling of the joints that lasts for at least six weeks, particularly if the swelling occurs on the same joints on both sides of the body. Swelling that occurs for less than six weeks could be a sign of multiple different things an example is acute viral polyarthritis, an inflammation of the joints caused by a virus.
Arthritis Care & ResearchAutoimmunity Reviews
Ra Blood Tests: What Lab Tests Show Rheumatoid Arthritis
To diagnose rheumatoid arthritis there is no one test that can on its own reach a diagnosis. Instead, there are a number of criteria that must be established in order to reach a rheumatoid arthritis diagnosis.
As part of the criteria for diagnosing rheumatoid arthritis, doctors will order multiple blood tests. These blood tests look for specific indicators that support the possibility that the patient could have rheumatoid arthritis.
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Get Tested For Antibodies
There are several blood tests accustomed to diagnose rheumatoid arthritis. the primary one your doctor may provide you with looks for proteins produced by your system called rheumatoid factors, says Dr. Vlad. These antibodies are found within the blood of 80% of individuals with RA. The second test looks for something called anti-cyclic citrullinated peptides , antibodies that mistakenly attack your own cells and are found in 60% to 70% of individuals with RA. Though neither test is conclusive, if you have got either or both antibodies, youre likely to own RA.
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.
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Question 3 Of : Symptoms