How is Rheumatoid Arthritis Diagnosed?

According to the Centers for Disease Control and Prevention (CDC), over 54.4 million adults in the United States are living with some form of arthritis, and over 1.3 million have a rheumatoid arthritis diagnosis. Rheumatoid arthritis (RA) is an autoimmune disease that is typically diagnosed between the ages of 30 and 60, but it can occur at any age, including young children. 

RA is linked to severe health complications, such as an increased risk of heart attack and stroke. There’s no cure for rheumatoid arthritis, but treatments can help manage the symptoms. Understanding rheumatoid arthritis diagnosis criteria can help you seek timely care.

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease. It occurs because the body’s immune system mistakes healthy cells in the joints for harmful substances and launches an attack by producing antibodies. These antibodies attack the synovium (joint tissues).

RA is not only restricted to the joints. It is a systemic disease, meaning it can affect the entire body. Rheumatoid arthritis can affect major organs such as the heart, lungs, and other tissues such as muscles, cartilages, and ligaments. In some cases, RA can cause severe swelling and pain that can lead to permanent disability.

Stages of RA: What Are the Stages of Rheumatoid Arthritis?

• Stage 1 of rheumatoid arthritis is early RA, when inflammation in your joints causes you to experience symptoms such as joint pain and stiffness. However, there is no visible damage in your joints on X-rays.

• Stage 2 of rheumatoid arthritis is more severe inflammation that has started to cause damage to the joint cartilage, resulting in worsening symptoms with reduced range of motion.

• Stage 3 of rheumatoid arthritis is associated with severe inflammation and bone damage, resulting in severe pain and loss of mobility as well as physical changes such as nodules.

• Stage 4 of rheumatoid arthritis is the advanced stage of the condition in which joint inflammation is no longer present, but joint damage continues to cause severe pain, swelling, and stiffness. 

Causes and Symptoms of Rheumatoid Arthritis

What Triggers Rheumatoid Arthritis?

The body’s immune system attacking healthy tissue is what triggers rheumatoid arthritis. Scientists believe this happens due to a combination of genetic and environmental factors, including certain genes, smoking, bacterial and viral infections, gum disease, and lung disease, that may play a role in triggering rheumatoid arthritis. 

Common Signs Leading to Rheumatoid Arthritis Diagnosis

The first symptoms of RA are typically joint stiffness and swelling that come and go. There are times when symptoms get better and times when they flare-up. 

As the disease progresses, other signs and symptoms may include: 

• Fatigue or tiredness

• Low-grade fever

• Pain and stiffness for at least 60 minutes after getting out of bed in the morning or after prolonged sitting

• Anemia

• Weight loss

• Weakness

• Rheumatoid nodules (firm lumps under the skin, mainly in the hands, elbows, and ankles)

Complications of Untreated Rheumatoid Arthritis

In addition to damaging the joints, rheumatoid arthritis can also affect the heart, lungs, vascular system, eyes, skin, and blood. RA increases the risk of heart attack or stroke by attacking the lining of the heart. The risk of heart attack is 60% higher one year after being diagnosed with RA compared to people who don’t have the disease. In addition, according to the CDC, people with RA are twice as likely to suffer from depression, which may be due to chronic pain and decreased mobility.

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How Do Doctors Diagnose Rheumatoid Arthritis?  

Medical History and Physical Examination

A rheumatoid arthritis diagnosis is usually made by a specialist called a rheumatologist. The RA diagnosis is made based on your symptoms, medical history, physical examination, blood results, and imaging tests. 

Blood Tests 

Blood tests for rheumatoid arthritis include:

• Complete blood count (CBC)

• Erythrocyte sedimentation rate (ESR or “sed rate”)

• C-reactive protein (CRP)

• Rheumatoid factor (RF) antibodies

• Anti-cyclic citrullinated peptide (CCP) antibodies

• Antinuclear antibody (ANA)

Blood tests such as ESR and CRP can help with RA diagnosis and give an indication of disease activity. CRP also correlates with radiographic evidence of joint inflammation and damage.

Immunologic parameters such as rheumatoid factor (RF), anti-CCP, and ANA are not specific for rheumatoid arthritis. About 60-80% of people with rheumatoid arthritis have positive RF, and about 40% have positive ANA assays. These blood tests can also be positive in people with other autoimmune conditions, connective tissue diseases, and infections. 

However, if you have a positive RF, anti-CCP, and ANA, it points towards RA. Your doctor can make a rheumatoid arthritis diagnosis in correlation with laboratory test results and clinical features (symptoms, medical history, and physical exam).

Imaging  

Imaging tests may be done to look for signs of damage to the joints, including:

• X-rays

• Ultrasound

• Magnetic resonance imaging (MRI)

X-rays are the first choice of imaging, given that they are inexpensive and widely available. Comparison of serial X-rays allows your healthcare provider to track disease progression. Doctors can obtain X-rays of small joints of the hands, wrists, and feet as well as large joints such as the shoulders, elbows, knees, hips, spine, and other joints. Relieve knee arthritis pain with these easy exercises.

Ultrasonography may be used to differentiate rheumatoid arthritis from other types of arthritis. Magnetic resonance imaging is sometimes used for rheumatoid arthritis diagnosis as it provides more detailed images. 

What Are The 7 Diagnostic Criteria For RA?

The 7 diagnostic criteria for rheumatoid arthritis, according to the American College of Rheumatology, are:

1. Morning stiffness for at least one hour.

2. Arthritis in at least 3 joints (knuckles, wrists, elbows, knees, ankles, or feet).

3. Arthritis in the small joints of the hands.

4. Symmetric arthritis on both sides of the body.

5. Rheumatoid nodules on bony prominences or around joints.

6. Positive rheumatoid factor on blood testing.

7. Radiographic changes on imaging studies, such as bone erosion or demineralization surrounding joints. 

If you meet the rheumatoid arthritis diagnosis criteria, your doctor will give you a confirmed rheumatoid arthritis diagnosis and start treatment. The ICD-10-CM diagnosis code for rheumatoid arthritis is M06.9.

What Disease Mimics Rheumatoid Arthritis?  

Common Diseases with Similar Symptoms: 

Some of the diseases that can cause similar symptoms and mimic rheumatoid arthritis include:

• Osteoarthritis

• Psoriatic arthritis

• Polymyalgia rheumatica (PMR)

• Fibromyalgia

• Systemic lupus erythematosus (SLE)

• Rheumatic fever

• Lyme Disease

• Relapsing Polychondritis

• Myelodysplastic Syndrome (MDS)

• Paraneoplastic Syndromes

• Sjogren Syndrome

• Sarcoidosis

Healthcare providers can make an accurate diagnosis based on symptoms, medical history, physical examination, blood tests, and imaging tests. 

Distinguishing Factors: RA vs Other Types of Arthritis

Symptoms and clinical features can help doctors make a diagnosis of rheumatoid arthritis versus other conditions. 

For example, degenerative joint disease (DJD) or osteoarthritis does not typically cause systemic symptoms. In addition, while rheumatoid arthritis typically causes morning stiffness, joint pain from osteoarthritis is usually relieved by rest. The location of the joint inflammation can also provide clues. Rheumatoid arthritis tends to cause joint inflammation in the small joints of the wrist and hands, while osteoarthritis typically affects large joints such as the knees. 

Differentiation between rheumatoid arthritis and gouty arthritis can similarly be made on the basis of clinical features. Gout tends to affect a single joint in the early stages and cause intermittent flares, although in the later stages, it can affect multiple joints. The presence of urate crystals in the joints are a diagnostic feature of gout and can help distinguish it from RA.

Treatment Options For RA

Medications

Arthritis medications are used to treat RA symptoms and prevent progression. Starting treatment as soon as you receive a diagnosis of rheumatoid arthritis is the most effective way to control disease activity. Some of the drugs used for treatment of rheumatoid arthritis include: 

• Painkillers such as acetaminophen (Tylenol), oxycodone (Roxicodone), and tramadol (Ultram)

• Nonsteroidal anti-inflammatory medications (NSAIDs) such as celecoxib (Celebrex), diclofenac (Voltaren), ibuprofen (Motrin, Advil), and naproxen (Aleve)

• Glucocorticoids (steroids) such as Celestone and Medrol

• Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, leflunomide (Arava), and hydroxychloroquine (Plaquenil). 

• Biologic response modifiers (a type of DMARD) such as abatacept (Orencia), adalimumab (Humira), tocilizumab (Actemra), and anakinra (Kineret). 

• Janus kinase inhibitors such as tofacitinib (Xeljanz).

Read more: Treating Autoimmune Conditions: Methotrexate vs. Humira

Common side effects of antirheumatic medicines include nausea, loss of appetite, diarrhea, headache, and hair loss.

Doctors may recommend joint replacement surgery or arthroplasty for people with severe rheumatoid arthritis in whom other treatments are not effective.

If you are having trouble affording medications for rheumatoid arthritis, use a BuzzRx prescription discount card and learn about other ways to save on your medications.

Lifestyle Changes for Rheumatoid Arthritis Management

Although there is no cure for rheumatoid arthritis, there are lifestyle changes one can make to improve quality of life. These include regular exercise, avoiding smoking, eating a healthy diet, and maintaining a healthy weight.

Early diagnosis of rheumatoid arthritis is important for successful management of the condition. Many effective treatments are available that can slow the progression of RA and limit the damage it causes. The important thing, therefore, is to consult a healthcare provider without delay if you have symptoms of rheumatoid arthritis.

FAQ on Diagnosis Rheumatoid Arthritis 

What Is The Prognosis for Rheumatoid Arthritis?

Long-term prognosis depends on timely diagnosis of rheumatoid arthritis, appropriate treatment, and other health conditions and risk factors. There is no cure for rheumatoid arthritis. It is a progressive disease that causes damage to the joints and other organs in the body. Up to 85% of people with RA have joint damage. 

Potential complications of RA include heart disease, interstitial lung disease, viral infections, carpal tunnel syndrome, osteoporosis, and lymphoma. People with untreated rheumatoid arthritis are twice as likely to die compared to those who don’t have this condition. 

However, early rheumatoid arthritis diagnosis and treatment can improve outcomes. 

What Are Usually The First Signs Of Rheumatoid Arthritis?

The first signs of rheumatoid arthritis are usually joint pain, stiffness, and swelling.

Can A Blood Test Confirm Rheumatoid Arthritis?

There is no single rheumatoid arthritis diagnosis test that can confirm the condition or rule it out. However, several blood tests can point toward rheumatoid arthritis, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) antibodies, and anti-CCP (cyclic citrullinated peptide or CCP) antibodies. Doctors can use the results of these blood tests and perform other diagnostic tests, such as imaging studies, to make a diagnosis of rheumatoid arthritis.