Created on: 01/04/08 - Email to friend - Print Page

Frequently Asked Questions About Rheumatoid Arthritis

Getting Diagnosed

How is rheumatoid arthritis diagnosed?

Unlike diabetes or kidney disease, arthritis cannot be diagnosed with a simple blood test. Instead, the diagnosis often takes time and is based largely on what the doctor hears from you (the medical history) and observes in you (the physical exam).

During the medical history, your doctor will ask questions about specific joints as well as how you feel in general. Because findings from the medical history play a major role in the diagnosis, it’s important to give your doctor clear and accurate and answers to questions, such as the following:
•    Do you have pain in many joints? People with RA often have pain in several joints at once as opposed to just one.
•    Do the same joints on both side of your body hurt at the same time? Symmetric pain is often as sign of rheumatoid arthritis. For example, if one wrist or knee is inflamed or painful, the other wrist or knee will likely be as well.
•    When is the pain the most severe? People with RA often feel worst when they first wake up and then later in the day when fatigue sets in.
•    Have you had periods of feeling weak and uncomfortable all over? Many people with RA notice generalized problem such as muscle aches, fatigue, stiffness, weight loss and flu-like symptoms.

Along with the medical history, a thorough physical exam will supply most of the information needed to make the diagnosis. Things your doctor will look for in the exam include:
•    Joint swelling, warmth and redness
•    Joint tenderness
•    Loss of motion in your joints
•    Joints that are out of alignment
•    Signs of rheumatoid arthritis in other organs, such as the heart, lungs or kidneys

After the medical history and physical examination, your doctor may order lab tests and imaging procedures to help confirm your diagnosis. These tests include:
•    Erythrocyte sedimentation rate (sed rate), a blood test that measures the rate at which red blood cells sink and form sediment in the bottom of a test tube. An elevated rate indicates inflammation.
•    C-reactive protein, a measure of inflammation that indicates disease activity
•    Rheumatoid factor, an antibody found in the blood of about 70 to 80 percent of people with RA
•    Antinuclear antibodies (ANA), antibodies that combine with the nuclei of cells and appear in about 30 to 40 percent of people with RA
•    Anti-CCP antibody, an antibody that binds to the amino acid citrulline, which is present in most people with rheumatoid arthritis. When the antibody is found in the blood, there a 90 percent or greater likelihood that a person has RA. A positive anti-CCP may iincidate a person's RA is more likely to progress quickly and be severe.
•    X-rays, which can show swelling of soft tissues and loss of bone density around affected joints
•    Bone scans to detect inflammation in joints
•    Magnetic resonance imaging (MRI), which can show synovitis, inflammation of the joint lining characteristic of RA, before damage shows up on X-ray, as well as inflammation in other organs

When should I see my doctor?

If you have not been diagnosed with rheumatoid arthritis, but suspect you may have it, it’s important to see a doctor to get a diagnosis and begin any needed treatment as soon as possible.

If you’re experiencing joint pain – as most people do at least occasionally – and wondering if it might be RA, the following are clues that it may be. At the very least, you should schedule an appointment with your doctor right away to have it checked out.

•    Regular morning joint stiffness
•    Persistent joint pain that does not improve
•    Joint pain that is getting worse over time
•    Joints that are swollen, red, hot or tender to the touch
•    Joint pain accompanied by fever
•    Several affected joints
•    Joint problems that affect with your ability to move or function

If you have already been diagnosed with arthritis, it is important to maintain regular appointments with your doctor to monitor your disease and response to treatment. Your doctor will let you know how often he or she wants to see you. But if you have an obvious change in or worsening or symptoms or an adverse response to medication, it’s important to contact your doctor even if it is not time for your regularly scheduled visit.

What kind of doctor should I see for my rheumatoid arthritis?

Your primary doctor for RA should be a rheumatologist. A rheumatologist is an internist (a doctor who specializes in internal medicine and treating adult diseases) who has additional training to diagnose and treat arthritis or related diseases that affect the joints, muscles, bones, skin and other tissues. Some rheumatologists may also have special training in pediatrics, orthopaedics, physical medicine, sports medicine or other medical fields.

While a rheumatologist is the best doctor to manage your RA, you will still need a primary care physician to manage other aspects of your health care. Unfortunately, having arthritis doesn’t make you immune to other health problems and may, in fact, increase your risk of some diseases.