Rheumatoid Arthritis Diagnosis
During your visit with your healthcare provider, he or she will try to figure out whether you have rheumatoid arthritis (RA) or some other health condition that explains your symptoms. There are some key tools that your doctor will use in diagnosing the disease. These include:
- Medical history
- Physical examination
- Diagnostic testing (laboratory testing and imaging)
RA diagnostic criteria
The diagnosis of RA is made primarily using results from the physical examination. However, there are a number of findings - laboratory testing and imaging as well as your medical history - that may help your doctor determine whether you have RA.
Your doctor will use the results from your assessment to see if you satisfy the diagnostic criteria for RA. RA cannot be diagnosed on the basis of a single test or symptom. There are two key medical organizations involved in creating and updating RA diagnosis and treatment guidelines: the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), respectively. Diagnostic criteria include:1,2
- Morning stiffness
- Joint involvement
- Blood testing
- Acute phase reactants
- Duration of symptoms
When your doctor takes your medical history, he or she will ask you questions covering several key areas. These will include questions about your symptoms, family medical history, other medical problems you may have, and any medications you are taking.
During the medical history, your doctor will be interested in knowing about the type of pain you are experiencing, including:
- location and pattern of pain throughout the body
- how pain affects your mobility and lifestyle
- whether the pain is affecting your sleep or sleep quality
- whether the pain is causing fatigue.
Existing medical problems
Your doctor will also want to know about any other medical problems you have. There are some medical problems that tend to occur along with RA and may be suggestive of the disease. Additionally, it is important to give your doctor a complete list of any medications, vitamins, or supplements that you are currently taking.
Family medical history
In addition, your doctor will also ask about your family medical history. Since there is a hereditary component to RA, information about any close relative with RA (or any other autoimmune disease) may help your doctor get a complete picture of your risk.
A physical exam is another part of getting an RA diagnosis. Your healthcare provider will check your blood pressure, pulse rate, heart and lung function. In addition, your doctor will evaluate your joints, paying extra attention to function, swelling, and pain. If you have RA, the physical exam will also help your doctor determine the severity of your disease. Knowing the severity of your RA will be used to guide treatment decisions.
Laboratory testing helps form a complete picture to help determine your diagnosis. There are certain substances that tend to be present in the blood of patients with RA. High levels of common components of blood are suggestive of inflammatory disease. Most laboratory tests for RA look at:
- Rheumatoid factor (RF)
- Anti-citrullinated protein antibodies (ACPA) (including anti-cyclic citrullinated peptide [anti-CCP] and anti-mutated citrullinated vimentin [MCV] antibody tests)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Antinuclear antibody (ANA)
- Complete blood count (CBC)
Your doctor may have x-rays taken of symptomatic joints. X-rays can reveal signs of inflammation and damage (bone erosion) that are indicative of RA. Other imaging tests that may be useful in diagnosis of RA include magnetic resonance imaging (MRI) or an ultrasound.