How is Diagnosis of Rheumatoid Arthritis Made?

RA diagnosis is made… with difficulty

Typically, diagnosis of Rheumatoid Arthritis takes some time. Many patients tell of continuous months or years of suffering before diagnosis is reached. Rheumatoid Arthritis often goes unrecognized even by health professionals because it is so widely misunderstood. There are many myths and images about Rheumatoid Arthritis which are generally held, but are not based in fact.

The presence of several symptoms of Rheumatoid Arthritis is often not adequate to diagnosis it because several RA symptoms are measured subjectively: i.e. pain, fatigue, stiffness, swelling, redness or warmth in joints. Also, upon first glance, some symptoms may seem similar to other conditions such as osteoarthritis or lupus.

RA diagnosis is made… with guidelines

In 1987, the American College of Rheumatology (ACR) developed a list of criteria to aid in the diagnosis of Rheumatoid Arthritis. At least four of the seven factors must be present and certain ones must persist for a period of six weeks or more. Briefly, they are as follows:

  1. Morning stiffness
  2. Arthritis of 3 or more joints with swelling or fluid, not bony overgrowth (Smaller joints are particularly of interest here.)
  3. Arthritis of hands or wrists
  4. Symmetric arthritis
  5. Rheumatoid nodules
  6. Positive Rheumatoid factor (determined by a blood test)
  7. X-rays which show erosions of bone in hands or wrists

Note: New criteria for diagnosis were approved by the ACR in October 2009. However, most doctors were trained to use the 1987 criteria. The new criteria for RA diagnosis are discussed in this post on the blog.

RA diagnosis is made… with blood tests

There is no single clinical test which alone can confirm the diagnosis of Rheumatoid Arthritis. In addition to a physical examination, there are several blood tests which can be helpful in the diagnosis of Rheumatoid Arthritis. They include the Rheumatoid factor antibodies; anti-CCP antibodies; sed rate (ESR); C-reactive protein; and antinuclear antibodies.

RA diagnosis is made… with more tests

X-rays, MRI’s or CAT scans can also be used to examine joints and demonstrate bone erosions (seen as tiny holes) or loss of cartilage. Other specialized tests may be used. They include ultrasound, biopsy of synovial tissue, arthroscopy, genetic marker tests, or extraction and examination of joint fluid (arthrocentesis). Often, Rheumatoid Arthritis is diagnosed by ruling out other diagnoses. Therefore, a doctor may run many more tests, looking for negative results in order to further confirm the RA diagnosis.

RA diagnosis is made… with treatment

Sometimes, Rheumatoid Arthritis is diagnosed because of what treatments are effective. For example, some doctors use administration of prednisone which causes symptoms to improve dramatically to confirm RA. This is not the most conventional or accurate method of diagnosis.

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