Rheumatoid Arthritis: Diagnosis: What To Expect When You Suspect Ra

Rheumatoid Arthritis: Diagnosis What to Expect When You Suspect RA

The Path to RA Diagnosis 

Once you begin to experience RA symptoms, it’s important to seek a definitive diagnosis. The path to diagnosis will typically start with a physical exam followed by a number of radiological and laboratory tests. Now, you may be wondering, “What’s the usual sequence of events when it comes to receiving an RA diagnosis from my rheumatologist?” Let’s take a look…

Physical Examination • During your exam, your doctor may ask you about: •

—A family history of RA —General symptoms you’re experiencing —Symptoms that have affected your ability to conduct everyday activities —If you’ve had any recent injuries that could be related to your joint pain —

• Your doctor will look for the presence of: —Swelling, tenderness, and warmth —Fluid on the joints —Reduced range of motion —Presence of rheumatoid nodules  

RA Diagnosis Criteria At least four of the following criteria must be met in order to receive a diagnosis of RA: 



• Morning stiffness that lasts at least one hour and is experienced for six weeks or more • Arthritis of three or more joint areas • Arthritis of the hand joints • Symmetrical arthritis • Rheumatoid nodules • Rheumatoid factor • Radiographic changes, such as bone erosion

Radiological Exams There are a variety of radiological exams that can help to determine if you have RA, they include, but are not limited to: 

•

• X-rays • Ultrasounds • MRIs

X-Rays • X-rays are typically the first course of radiological assessment and can help to create a “baseline” view of disease progression •

• X-rays may appear normal or show slight swelling of the soft tissue early in the disease process. Later in the disease, x-rays may reveal bony erosions or joint damage •

• X-rays are an excellent tool in tracking the progression of joint damage, however, often less effective in the diagnosis process when compared to other radiological exams

Ultrasound • Ultrasounds are excellent for early stage RA; ultrasounds help to identify inflamed membranes surrounding larger joints and hard-to-reach smaller joints

MRI • Magnetic Resonance Imaging, or MRI, is becoming a more commonly used tool in RA diagnosis •

• MRIs can show all aspects of the joint simultaneously and may help to detect damage before conventional radiographs such as x-rays

Laboratory Tests There are a number of blood/joint fluid tests that can be performed to determine an RA diagnosis; they may include, but are not limited to: 



• Rheumatoid Factor • Anti-Citrullinated Peptide (Anti-CCP) • Erythrocyte Sedimentation Rate and C-Reactive Protein (ESR & CRP) • • •

•

Rheumatoid Factor • Rheumatoid Factor, or RF, is an antibody often found in the blood of individuals with autoimmune diseases, like RA. An antibody is a special protein made by the body’s immune system to help fight “foreign invaders” present in the body •

• An RF blood test may be the first of many tests performed, however this test can be tricky. Early in the disease process, RF may not be present in the body, some people with RA never show evidence of RF in the blood. There is also the potential for false positives in individuals who will never develop the disease •

• Some people who have other autoimmune diseases such as lupus and scleroderma may test positive for rheumatoid factor, so it’s important to have more testing to determine a definitive diagnosis

Anti-CCP • The Anti-Citrullinated Peptide blood test measures levels of antibodies against cirtrullinated antigens and is helpful in ruling out other autoimmune diseases •

• Anti-CCP may help to predict the progression of the disease •

• Anti-CCP blood tests typically have fewer false positives than the RF test

ESR & CRP • The Erythrocyte Sedimentation Rate (ESR) and CReactive Protein (CRP) blood tests help to measure markers of inflammation in the body. While they cannot be used alone in diagnosis they may be affective in monitoring levels of inflammation in the body

The Diagnosis: “How Will My Rheumatologist Know If I Have RA?” • Once your rheumatologist receives and compiles your physical exam, radiological, and laboratory reports he or she will be able to more adequately diagnosis your symptoms as RA or another condition •

• Remember: There is no single test that can determine if you have RA or how your RA will progress so it’s important to work with your doctor to continuously monitor your RA in order to determine if you’re on the right treatment plan