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Diagnosing Rheumatoid Arthritis

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By Editorial Team

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: July 2024 | Last updated: August 2024

Rheumatoid arthritis (RA) is a chronic (long-term) condition that causes:1

  • Swelling
  • Joint pain
  • Inflammation
  • Stiffness

RA symptoms tend to occur in joints evenly on both sides of the body.1

If left untreated, RA will destroy the joints. This can make it hard for a person with RA to carry out normal daily tasks and keep a job. The inflammation of RA can lead to other conditions such as:1

  • Heart disease
  • Loss of bone mass (osteoporosis)
  • Certain types of cancer

Starting RA treatment early may prevent or slow joint damage and disability. This is why getting a correct diagnosis for RA as early as possible is needed.1

But RA can be hard to tell apart from other forms of arthritis. An obvious sign of RA is the wearing down of the cartilage, or cushioning tissue, between the joints. Another clear sign of RA is joint nodules. These are lumps that form near joints. But these signs often do not appear until someone has had RA for a long time or has poorly controlled RA.1

Medical history and physical exam

The first step your doctor will take to diagnose you with RA is take a full medical history and conduct a physical exam. In going over your medical history, your doctor may ask about:1,2

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  • Your past and current health conditions
  • Past injuries and surgeries
  • Any drugs and supplements you are taking
  • Diseases in your family history, especially autoimmune or inflammatory conditions
  • Your exercise and eating habits

A physical exam often starts with some basic checks, including your:1,2

  • Weight
  • Heart rate
  • Blood pressure

Your doctor may look at your eyes, ears, and skin and will listen to your lungs. They will also look at your hands and feet. This is because those are the joints in which RA often begins. Your doctor will then ask about a wide range of issues, including:1,2

  • Your symptoms, such as:
    • Morning stiffness
    • Energy levels
    • Pain
  • How severe your symptoms are
  • When your symptoms began and how they have changed over time
  • What makes your symptoms better or worse
  • How these symptoms impact your daily life
  • Whether you have rashes that come and go

Blood tests

A few blood tests can help your doctor diagnose RA. These tests include:1,2

  • Rheumatoid factor (RF): This looks for the RF antibody. This is a protein that people with RA may have in their blood.
  • Anti-cyclic citrullinated peptide (anti-CCP) antibody: This is another antibody that people with RA often have in their blood.
  • Complete blood count (CBC): This measures blood cell counts, including white blood cells, red blood cells, and platelets.
  • Erythrocyte sedimentation rate (sed rate): This measures inflammation in the body.
  • C-reactive protein (CRP): This also measures inflammation.

Your doctor may also run tests to check:2

  • Your electrolyte levels
  • Your muscle health
  • How well your organs are working, including your:
    • Kidneys
    • Thyroid
    • Liver

Imaging tests

Imaging tests will help your doctor check for joint damage and how severe that damage is. These tests include:1,2

  • X-ray
  • Magnetic resonance imaging (MRI)
  • Ultrasound

MRI and ultrasound can be more helpful in detecting RA joint damage in its early stages. Meanwhile, X-rays can only detect RA in its later stages. This is because joint damage must be more severe in order to be seen on X-rays. But X-rays can still help monitor RA as it progresses and help rule out other causes of joint pain.2

Other imaging tests are used less often, such as:2

  • Computed tomography (CT) scans
  • Positron emission tomography (PET) scans
  • Bone scans
  • Dual-energy X-ray absorptiometry (DEXA) scans

Ruling out other conditions

Your doctor will look at your medical history, family history, symptoms, lab results, and imaging tests to rule out other conditions that have symptoms similar to RA. These include:1

  • Inflammatory arthritis caused by a virus or other condition
  • Lyme disease
  • Early stage psoriatic arthritis
  • Lupus
  • Sjögren's disease
  • Mixed connective tissue disease
  • Other autoimmune conditions
  • Arthritis caused by diabetes or long-term suppression of the immune system such as due to cancer treatment
  • Gout
  • Inflammatory bowel disease
  • Osteoarthritis (arthritis caused by overuse)
  • Carpal tunnel syndrome
  • Fibromyalgia

If you are diagnosed with RA, many treatment choices exist. Treatment can help:2

  • Relieve pain
  • Reduce swelling and inflammation
  • Prevent or slow joint damage