What Lab Tests Indicate Rheumatoid Arthritis

What Exactly Is Rheumatoid Arthritisand How Do You Know If You Have It

Rheumatoid arthritis is an autoimmune and inflammatory disease that mainly affects the bodys joints, according to the Centers for Disease Control and Prevention .

The condition, per the CDC, commonly affects the joints in the hands, wrists, and kneesand occurs when the lining of those joints becomes inflamed, damaging the joint tissue. That damage can eventually lead to long-lasting or chronic pain, unsteadiness, and deformity.

The symptoms of RAwhich can include pain, stiffness, tenderness, and swellingcan go through phases where theyre worse and better . But some symptoms of RA can mimic those of other conditionsheres what to look out for, and how to know if its due to RA or something else.

Other Diagnostic Methods Used To Confirm Rheumatoid Arthritis

Blood tests arent the only method that can be used to diagnose rheumatoid arthritis. You might also have a variety of other tests done to help confirm rheumatoid arthritis. These include:

• Physical assessment. A physical assessment can help determine how much your symptoms are impacting your daily life. You might be asked how well you can do daily tasks such as showering, eating, and dressing. A physical therapist might also assess your grip, walk, and balance.
• Joint scan. A joint scan looks for inflammation and damage in your joints. It can help confirm a rheumatoid arthritis diagnosis.
• Imaging tests. X-rays and MRIs create detailed pictures of your bones, muscles, and joints that can help diagnose rheumatoid arthritis.

Who Should Get Testing

Patients who experience inflammation, pain, or loss of mobility in joints should discuss testing for rheumatoid arthritis with their doctor, especially if symptoms occur in multiple joints or in matching joints on both sides of the body, such as both wrists. Other symptoms of rheumatoid arthritis include:

• Stiffness in the morning for 30 minutes or longer
• Fatigue
• Dry eyes and mouth
• Firm lumps beneath the skin

These symptoms are often due to something other than RA when they last less than six weeks. The longer a patient experiences symptoms, the more likely the symptoms are to be due to RA.

Diagnosing rheumatoid arthritis in its early stages can be challenging, as patients may experience few symptoms, but early diagnosis is important because early treatment may prevent joints from worsening or at least slow the process. When symptoms are present, they often differ from person to person and mimic the symptoms of other diseases. Testing is an important part of the process of determining whether symptoms are due to RA or another condition.

After receiving a diagnosis of RA, its important for patients to continue rheumatoid arthritis testing. Testing can assist doctors in assessing the severity of RA, as well as monitoring the efficacy of treatment, tracking disease progression, and detecting potentially serious side effects of treatment drugs.

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Find Support For Rheumatoid Arthritis

When you join myRAteam, the social network and online support group for those living with rheumatoid arthritis, you gain access to a community of more than 169,000 people who understand what their fellow members are going through.

What has been your experience with blood tests for RA? Do you have questions about how blood tests diagnose RA? Comment below or start a conversation on myRAteam.

What Happens If A Blood Test Is Inconclusive

Understandably, taking a blood test can bring anxiety and confusion for people who think they may have rheumatoid arthritis. People worry about what happens if a blood test is inconclusive. To avoid an inconclusive result, doctors use multiple blood tests and consider other medical factors, such as genetics and physical symptoms to determine a diagnosis of RA. One myRAteam member wrote, I have RA that doesnt show up in the blood test. I have to be given a special blood test, which I think costs a lot.

Other members have had similar problems with blood tests. My RA has never shown up in blood tests. Because of that, it took years to get a diagnosis. Now I have disfigured hands and feet, wrote another member.

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Getting Tested For Rheumatoid Arthritis

Testing for rheumatoid arthritis is ordered by a doctor or specialist if indicated by a patients symptoms. Blood and urine samples used for testing can be obtained in a doctors office or other medical setting.

Synovial fluid is a liquid that is located in spaces between a persons joints, helping to cushion ends of bones and reduce friction during movement. For a synovial fluid analysis, a sample of synovial fluid is obtained during a procedure called a joint aspiration or arthrocentesis. During a joint aspiration, a doctor uses a needle to withdraw a sample of synovial fluid from a joint.

The Role Of Rheumatoid Arthritis Testing

Rheumatoid arthritis testing is used to diagnose RA, evaluate the severity of a patients disease, monitor treatment, and detect potential side effects of treatment drugs:

• Diagnosis: Diagnostic testing helps determine the cause of a patients symptoms. If a doctor is concerned that a patients symptoms may be related to rheumatoid arthritis, testing can assist in diagnosing RA and ruling out other health conditions.
• Evaluating severity: The results of several laboratory tests can inform doctors about the severity of a patients RA, the amount of joint damage, and the prognosis or expected course of the disease.
• Treatment monitoring: Monitoring patients diagnosed with RA involves regular medical care, including doctors visits, laboratory testing, and imaging tests. Combining these strategies can assist doctors in tracking the progression of RA and understanding if treatment is effective.
• Detecting side effects: Testing may also be used to detect side effects caused by treatment drugs, as well as other health conditions that are more common in patients with rheumatoid arthritis, including osteoporosis, heart disease, and diabetes.

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Other Commonly Used Laboratory Investigations

Complements C3 and C4

Decreased levels of complement arise from immune-complex disorders such as SLE and other selected forms of vasculitis. Complement testing is useless for screening of SLE but is often used to monitor disease activity in patients with SLE.11

Serum uric acid

Serum uric acid measurement is helpful in monitoring the extent of hyperuricemia in patients with gout. The prevalence of asymptomatic hyperuricemia among men is 5% to 8%, and fewer than 1 in 3 people with hyperuricemia will ever develop gout.12 It is important to note that asymptomatic hyperuricemia does not confer a diagnosis of gout and need not be treated unless serum uric acid levels are persistently above 760 µmol/L for men or 600 µmol/L for women. At these levels there is an increased risk of renal complication.13 Serum uric acid testing is often ordered for the patient with acute monoarthritis. Unfortunately, this will not be helpful in the diagnosis because of the high prevalence of asymptomatic hyperuricemia. A diagnosis of acute gout can only be made with certainty by joint aspiration to confirm the presence of urate crystals under polarized light.

Antibodies to extractable nuclear antigens

Antineutrophil cytoplasmic antibody test

What Does My Ra Treatment Look Like

My treatment will be overseen by a specialist in autoimmune diseases, known as a rheumatologist. A treatment plan can include specific medicine including disease-modifying anti-rheumatic drugs , pain management , proper nutrition, massage therapy, occupational and physical therapy, etc.

My rheumatologist needs to find the right medicine to help my RA. Please know finding the right medication and combination of treatments may take time.

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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
• Fatigue

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.

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Blood And Pathology Tests For Arthritis

Before any tests are done, the doctor will ask you about your symptoms and will often examine you for signs of arthritis or other autoimmune features. Then tests may be done.

Your symptoms and signs on physical examination are more important for making a diagnosis than the results of the tests.

What are blood tests and pathology tests used for?

• Confirming a diagnosis of arthritis or autoimmune disorder
• Monitoring disease activity and response to treatment
• Checking for side effects from medicines

Are all types of arthritis diagnosed by blood tests?

Most forms of arthritis can be diagnosed by blood tests. The doctor may use blood tests to provide support for the diagnosis made on the symptoms and signs, or to help rule out other types of arthritis or conditions that cause similar symptoms. No blood or pathology tests may be required to diagnose some conditions such as osteoarthritis or chronic back pain.

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When To Seek Medical Advice

You should see your GP if you think you have symptoms of rheumatoid arthritis, so your GP can try to identify the underlying cause.

Diagnosing rheumatoid arthritis quickly is important because early treatment can help stop the condition getting worse and reduce the risk of further problems such as joint damage.

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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.

Crunching Numbers

How T2T Works

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Hematocrit And Hemoglobin Counts

These measure the number and quality of red blood cells. If you have chronic inflammation the number of red blood cells usually is low . Low hematocrit and hemoglobin counts may be signs that your medication is causing a loss of blood from your stomach and passing through your bowel. Low counts also may indicate a decrease in red blood cell production.

Early Diagnosis Of Ra Is Important

If you think you might have its time to call your doctor, who will evaluate you and potentially connect you with a specialist, called a rheumatologist, who is trained in treating inflammatory disease. Getting an early, accurate RA diagnosis is important not only to control your symptoms, but to prevent permanent joint damage from occurring.

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Can A Blood Test Predict Rheumatoid Arthritis

While you cant prevent rheumatoid arthritis, a recent study suggests that it may be possible to predict the onset of the disease through a simple blood test. And researchers are excited by the possibility that, armed with that foreknowledge, doctors may be able to slow or alter the destructive course of the disease once it appears.

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:

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Diagnosing Rheumatoid Arthritis With The Rheumatoid Factor Test

Patients who test positive for rheumatoid factor arent necessarily diagnosed with rheumatoid arthritis right away. There must also be a clear history of consistent rheumatoid arthritis symptoms.

If your doctor suspects symptoms of rheumatoid arthritis, other criteria must first be taken into consideration before reaching a diagnosis. The presence of rheumatoid factor alone does not typically lead to an immediate rheumatoid arthritis diagnosis. Doctors look at physical symptoms, medical history and may conduct other blood tests, like anti-CCP, as well as imaging scans to help identify the condition.

Depending on the final diagnosis, in some cases the presence of rheumatoid factor in a patients blood may help determine the type of treatment that will be provided to that patient, such as disease-modifying antirheumatic drugs .

A positive rheumatoid factor test along with a rheumatoid arthritis diagnosis can potentially help the doctor determine a prognosis and an appropriate course of treatment. This may depend on a variety of factors.

Measures To Reduce Bone Loss

Inflammatory conditions such as rheumatoid arthritis can cause bone loss, which can lead to osteoporosis. The use of prednisone further increases the risk of bone loss, especially in postmenopausal women.

You can do the following to help minimize the bone loss associated with steroid therapy:

• Use the lowest possible dose of glucocorticoids for the shortest possible time, when possible, to minimize bone loss.
• Get an adequate amount of calcium and vitamin D, either in the diet or by taking supplements.
• Use medications that can reduce bone loss, including that which is caused by glucocorticoids.
• Control rheumatoid arthritis itself with appropriate medications prescribed by your doctor.

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Rf Test: What Is The Normal Range For A Rheumatoid Factor Test

The rheumatoid factor is an antibody present in the blood of many patients with rheumatoid arthritis. Doctors measure the level of rheumatoid factor by performing a blood test. A positive rheumatoid factor test means that the level of rheumatoid factor in the patients blood is considered to be high.

Rheumatoid factor was first described in connection to rheumatoid arthritis in 1940. For decades, a positive rheumatoid arthritis test was used to diagnose those with symptoms of rheumatoid arthritis.

Today, a positive rheumatoid factor test is mostly used as a supportive tool to help doctors reach a diagnosis. Because rheumatoid factor may be present in other conditions, and in some healthy people, the test for it should be combined with other tools and criteria for it to be useful in diagnosis. A positive rheumatoid factor test is also used to determine a general prognosis for rheumatoid arthritis in adults and children.

Types Of Rheumatoid Arthritis Tests

In order to diagnose rheumatoid arthritis, a doctor begins by discussing a patients symptoms, understanding their medical history, and conducting a physical examination.

Laboratory tests are performed to help diagnose rheumatoid arthritis, to distinguish it from other forms of arthritis and conditions with similar symptoms, and to evaluate the severity of the disease. Laboratory tests used to diagnose and evaluate rheumatoid arthritis, as well as to rule out other conditions, include:

Laboratory tests used to monitor rheumatoid arthritis and detect treatment side effects include regular testing of c-reactive protein and erythrocyte sedimentation rate, as well as hemoglobin, albumin, and platelet count. Additional tests used to detect side effects of treatment depend on the type of treatment or medication a patient is receiving.

Genetic testing may be used in planning treatment for rheumatoid arthritis. In order to understand if a patients body is able to metabolize a type of medication called thiopurine prodrugs, doctors may test patients for variants in the thiopurine methyltransferase and nudix hydrolase 15 genes. Testing for drug metabolism is important to determine a safe dosage of these medications.

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Other Autoantibodies In Ra

RF and anti-CCP are the main autoantibody tests that are used in RA. However, there are several others including antibodies to carbamylated proteins , anti-mutated citrullinated vimentin and several others. In addition, when an individual initially develops RA, their health care provider may perform other tests that can be related to other autoimmune conditions that can be similar to RA. These tests include anti-nuclear antibodies and several others. If you have abnormalities of these other tests, please ask your health-care provider for more information.

Diagnosis And Tests For Rheumatoid Arthritis

There is no definitive test for rheumatoid arthritis and other conditions can cause similar symptoms. Your GP will ask about your symptoms, check the movement of your joints and perform a physical examination.

If they think you have rheumatoid arthritis, theyll recommend a blood test and refer you to a rheumatologist .

A blood test will check for several different proteins that can indicate rheumatoid arthritis. Your blood test may measure:

• Anti-cyclic citrullinated peptide antibodies that attack healthy tissue in your body
• C-reactive protein levels a measure of inflammation
• Erythrocyte sedimentation rate a measure of inflammation
• Rheumatoid factors proteins produced by your immune system when it mistakenly attacks healthy tissue
• Your full blood count this can:
• Check if you have anaemia, which is common in people with rheumatoid arthritis
• Help rule out other conditions
• Indicate your general health

To identify the type of arthritis you have and monitor how the disease progresses over time, your rheumatologist may also take images of your joints, such as:

If you receive a diagnosis of rheumatoid arthritis, your rheumatologist may assess how you cope with everyday tasks.

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