The Role of Physical Exams in Diagnosing RA

Rheumatoid arthritis (RA) is an autoimmune form of arthritis. It is caused by immune cells attacking the joints, most commonly the joints of the fingers, wrists, elbows, and toes. This causes inflammation, pain, and damage in these areas.

In the early stages of RA, it can be difficult to distinguish RA from other types of arthritis. One of the tools your doctor will use to diagnose RA is a physical exam.¹

What symptoms lead doctors to suspect RA?

Joint pain is unfortunately common with aging. It can be caused by injury, overuse, or chronic (ongoing) diseases. Chronic diseases that can cause joint pain include:²

• RA
• Osteoarthritis
• Gout
• Fibromyalgia
• Psoriatic arthritis
• Lupus

RA has very few specific symptoms. Morning stiffness is one hallmark of RA. That means it is one of the most specific symptoms of the condition. Morning stiffness refers to difficulty moving your joints after resting for a long time. Morning stiffness, as its name suggests, is most common in the morning. But if you have RA, you can get this stiffness after any long rest.¹

Your doctor is more likely to try to figure out whether you have RA by learning about the other symptoms you are feeling. Because RA is caused by inflammation, you may experience other symptoms related to inflammation. These include:¹

• Weight loss
• Weakness
• Tiredness (fatigue)

What is my doctor looking for?

After talking to you about your symptoms, your doctor will want to look for signs of RA. They will likely look at each joint on your arms and legs, especially the joints causing you pain. They will look for things like swelling, redness, or rashes. Swelling and redness are signs of inflammation. Rashes can be signs of a different disorder, psoriatic arthritis.³

Your doctor may also gently press, or palpate, each joint. Inflammation in the affected joints may make them feel soft or "doughy." This is different from osteoarthritis, which causes firm and uneven joints. They might also check the range of movement in each joint. In RA it is common to have motion limits in the affected joints. This exam will allow your doctor to assess if moving each joint is painful.³

RA is also unique in which joints it affects. RA usually affects the same joint bilaterally, meaning on both sides of the body. RA can be seen in almost all of the joints in the fingers and hands. It rarely affects the distal interphalangeal or “DIP” joint. This is the knuckle closest to the tip of each finger.¹

What happens after the exam?

If your symptoms and physical exam suggest that you may have RA, your doctor will want to follow up. This could include another visit in 3 to 6 months to see how your symptoms are changing. They may also want to order lab work. Because RA is an autoimmune disease, there are certain substances in the blood that your doctor can look for to confirm the diagnosis.¹

If you have more questions or if you believe you may have RA, speak to your doctor.