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.
The Difference Between Rheumatoid Arthritis And Osteoarthritis
Like RA, people with osteoarthritis can experience painful and stiff joints that make moving around difficult.
People with OA may have joint swelling after extended activity, but OA doesnt cause any significant inflammatory reaction that typically results in redness of the affected joints.
Unlike RA, OA isnt an autoimmune disease. Its related to the natural wear and tear of the joints as you age, or it can develop as a result of trauma.
OA is most often seen in older adults. However, it can sometimes be seen in younger adults who overuse a particular joint such as tennis players and other athletes or those whove experienced a severe injury.
RA is an autoimmune disease. The joint damage from RA isnt caused by normal wear and tear. Its caused by your body attacking itself.
What Tests Can Be Done To Detect Arthritis
Blood Tests to Diagnose Arthritis Your doctor will use several blood tests to help diagnose you with Rheumatoid Arthritis
A chronic autoimmune inflammatory disease that affects the joints.
arthritis and other inflammatory conditions. Blood tests are usually fast. The doctor sends you to a lab where a worker puts a needle into one of your veins.
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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.
Blood Tests Commonly Used In Ra
Erythrocyte Sedimentation Rate : ESR tests measure the level of inflammation in the body. However, the test does not reflect exactly where in the body the inflammation is or what is causing it. ESR can also be affected by other conditions besides inflammation, so it is used alongside other tests
C-Reactive Protein : CRP tests measure the level of inflammation in the body by measuring the amount of C-reactive protein in the blood. The test is not specific enough to diagnose a particular type of arthritis or disease, so it is used alongside other tests.
Rheumatoid Factor : The RF test is commonly used to help diagnose rheumatoid arthritis . However, a positive RF test does not always mean a person has RA, as there are several conditions that give positive RF results. Healthy people without RA can also test positive for RF, particularly older people. This does not mean they will develop the condition.
Anti-Cyclic Citrullinated Peptide antibody: Anti-CCP antibodies are commonly present in people with rheumatoid arthritis . This test is useful in the early stages of RA or in borderline cases, as it is a stronger indicator of RA than the rheumatoid factor test. As not all people with early RA test positive, the doctor will use other tests and examinations so the diagnosis is more reliable.
CONTACT YOUR LOCAL ARTHRITIS OFFICE FOR MORE INFORMATION ON ARTHRITIS. For more information about various laboratory tests and how they are used see www.labtestsonline.org.au.
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Causes And Risk Factors
RA is caused when the immune system attacks healthy joint tissues. Researchers dont know what causes the immune system to attack the synovium, the lining of the joints. But this process causes inflammation that can destroy bone and cartilage, stretching and weakening tendons and ligaments.
This leads to pain and loss of joint shape and alignment.
Rheumatoid Arthritis Diagnostic Tests Market Insights
Rheumatoid arthritis is an autoimmune disease in which the bodys own immune system attacks its joint tissues, which leads to inflammation of joint lining. Such inflammation of joint lining causes pain, stiffness, swelling, warmth, and redness.
The global rheumatoid arthritis diagnostic tests market is estimated to account for US$ 3,480.9 Mn in terms of value by the end of 2027
Global Rheumatoid Arthritis Diagnostic Tests Market: Drivers
Increasing prevalence of RA is expected to propel growth of the global rheumatoid arthritis diagnostic tests market over the forecast period. For instance, according to the study, Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017, published in the journal Annals of the Rheumatic Diseases, in November 2019, the age-standardized point prevalence and annual incidence rates of RA were 246.6 and 14.9 in 2017, which increased by 7.4% and 8.2% from 1990, respectively.
Moreover, increasing expenditure for the treatment and management of RA is also expected to aid in growth of the market. For instance, according to the study, Mortality, disability, and healthcare expenditure of patients with seropositive rheumatoid arthritis in Korea: A nationwide population-based study, published in the journal PLOS One in January 2019, the annual health expenditures were significantly larger for patients with RA than for controls.
Key features of the study:
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Home Remedies For Managing Ra
In addition to medication and surgery, patients may want to ask their doctor about simple therapies they can do at home, such as exercise and diet.
Low impact exercises can strengthen muscles and improve flexibility. These include walking, water aerobics, swimming and yoga.
According to a 2012 review published in Open Access Journal of Sports Medicine by Shirley Telles and Nilkamal Singh, yoga has shown some promise in reducing pain, improving function and providing mental health benefits.
A small 2019 study by researcher Surabhi Gautam and colleagues published in Restorative Neurology and Neuroscience found that yoga eased physical symptoms and improved mental health.
Evidence suggests that eating a healthy diet with anti-inflammatory foods can ease RA symptoms. There isnt a specific regimen to follow, but a 2018 review recommended the Mediterranean diet and fish oil for people with RA, Today reported.
In general, keeping a healthy weight and getting the proper nutrition helps manage inflammation that can worsen RA.
Foods that may manage RA symptoms include:
- Fatty fish like salmon, sardines and tuna
- Fruits and vegetables
- Olive oil
Getting Enough Sleep
People with RA often suffer from fatigue and pain that can get worse during flare-ups. Make sure to get plenty of rest.
Hot and Cold Therapy
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What Is The Prognosis For People Who Have Rheumatoid Arthritis
Although there is no cure for rheumatoid arthritis, there are many effective methods for decreasing the pain and inflammation and slowing down the disease process. Early diagnosis and effective treatment are very important.
Extensive research is being done to learn the cause of rheumatoid arthritis and the best methods of treatment.
Last reviewed by a Cleveland Clinic medical professional on 11/17/2017.
Small Blood Vessel Nerve Symptoms
RA may damage the small vessels that feed the nerves. This damage is known as rheumatoid vasculitis . RV impacts only about 1 percent of those with RA, but the condition may be severe. RV can cause damage to the nerves of the hands and feet, which can disable the person impacted. RV may lead to damage to multiple nerves in the body. Signs of RV may include:2
- Numbness, tingling, burning, or pain in the hands or feet
- Muscle weakness or paralysis
- Muscle wasting, or loss of muscle
Although rare, RV may affect the small vessels in the brain. This may increase the risk of conditions such as stroke.2
What Will My Results Tell Me
The rheumatoid arthritis at-home test can tell you if you have elevated biomarkers that might indicate a high likelihood of rheumatoid arthritis. You can use your results report to engage with your primary care physician or a rheumatologist for further diagnostics and treatment if necessary. Read more about RA blood testing.
Who Should Take This Test
Anyone experiencing joint inflammation, joint pain/stiffness, loss of appetite or recurring bouts of fatigue should consider taking the imawareâ¢ rheumatoid arthritis test. Anyone that has a family of history of RA should also be screened. This test is designed to provide awareness of RA before symptoms appear, as the average onset age for rheumatoid arthritis is between 30 and 60 years old.
What Is The Significance Of An Anti
The main purpose of conducting this test is to differentiate RA from other types of arthritis. Your immune system is capable of protecting your body from harmful microorganisms. In some cases, your body gets confused and considers its own cells as foreign. This results in the formation of antibodies against your cells, which causes autoimmune disorders. Few examples of autoimmune conditions include:
- Juvenile diabetes
- Thyroid diseases
- Pernicious anemia
In case of RA, the body produces antibodies against its own peptide proteins. Diagnosis of these anti-CCP antibodies in your blood helps in early treatment. These are found in your blood even before you start to show RA symptoms. However, even if symptoms subside, you may still test positive for RA. So, this test cannot be used to monitor RA progression as there may be fluctuations in levels of antibodies.
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How Is Rheumatoid Arthritis Diagnosed
The diagnosis of rheumatoid arthritis is based on a combination of factors, including:
- Morning stiffness that lasts at least one hour and has been present for at least six weeks
- Swelling of three or more joints for at least six weeks
- Swelling of the wrist, hand, or finger joints for at least six weeks
- Swelling of the same joints on both sides of the body
- Changes in hand x-rays that are hallmarks of rheumatoid arthritis
- Rheumatoid nodules of the skin
- Blood test that is positive for rheumatoid factor* and/or anti-citrullinated peptide/protein antibodies
* The rheumatoid factor may be present in people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. A test called CCP antibody can sometimes help to determine whether the rheumatoid factor antibody is due to rheumatoid arthritis or some other disease. This is why the diagnosis of rheumatoid arthritis is based on a combination of several factors and NOT just the presence of the rheumatoid factor in the blood.
It is also important to note that not all of these features are present in people with early rheumatoid arthritis, and these problems may be present in some people with other rheumatic conditions.
In some cases, it may be necessary to monitor the condition over time before a definitive diagnosis of rheumatoid arthritis can be made.
Measuring Disease Activity In Rheumatoid Arthritis
Different types of tests are used to show whether treatment is working.
In the past, most doctors who treated rheumatoid arthritis used their instincts and informal questions, like How are you feeling? to make decisions about treatment, such as when to change or add a medication in order to get a patients symptoms under control. However, a revolution has occurred in the management of RA, now that research strongly indicates patients fare much better when doctors use a treat-to-target approach.
In T2T, the doctor adjusts a treatment regimen as necessary to achieve a specific goal, which in most cases is remission or low disease activity . To follow a treat-to-target approach, you need to have a target, says rheumatologist Bryant England, MD, PhD, an assistant professor at the College of Medicine at the University of Nebraska Medical Center.
But how can a doctor tell whether progress is being made toward the goal or whether a new treatment plan is needed? In 2019, Dr. England led a panel of experts, convened by the American College of Rheumatology , that recommended five effective and practical tools for measuring disease activity in T2T strategies. Another panel chose three tests for evaluating functional status, that is, how much RA limits a patients ability to perform daily tasks.
If your doctor isnt using tools to measure your disease activity and functional status, ask why. But first, learn a bit about how they work.
How T2T Works
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What Are The Signs And Symptoms Of Ra
With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.
Signs and symptoms of RA include:
- Pain or aching in more than one joint
- Stiffness in more than one joint
- Tenderness and swelling in more than one joint
- The same symptoms on both sides of the body
- Weight loss
Can My Doctor Use Imaware Results
Yes. All of our tests are performed by CLIA-certified labs, the gold standard in lab testing quality regulation. Within your results report you will also find detailed information intended for your healthcare professional. They can use this information to interpret your test results clearly. To see an example of this, you can request a sample report at the top of this page.
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Family & Personal Medical History
The patients medical history and family history are important factors in helping to reach a RA diagnosis. Studies have shown that the average risk of someone in the general population developing RA is about 1%. However, if there is a family history of the disease, the risk of another family member developing RA increases.
When diagnosing RA doctors ask about the following:
- Patients family members who have or had RA
- Patients existing or past autoimmune disorders
- Patients family members with other autoimmune disorders
- Other medical conditions, illnesses or complications
Depending on each patients unique set of answers, it can help doctors identify factors that lead to a RA diagnosis.
Other Tests For Seropositive Rheumatoid Arthritis
Blood tests are not only used to detect RF and anti-CCP antibodies. They’re also used to reveal if you have:
- Anemia, or low red blood cell count, which occurs in up to half of people with RA
- A high erythrocyte sedimentation rate, also known as a sed or ESR rate, a crude measure of inflammation in your body
- High C-reactive protein levels, another marker of inflammation
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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.
What Are The Symptoms Of 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.