RA is a problem with your immune system. If you don’t diagnose and treat it in time, it could harm your joints. Most people with RA do have some sort of joint damage. Most of it happens in the first 2 years.
Your regular doctor may order blood tests and X-rays to help confirm a diagnosis. Or you may be sent to someone who specializes in diagnosing and treating RA. This type of doctor is called a rheumatologist.
First Symptoms of RA
Sometimes, RA can be tough to figure out. Symptoms may come and go, and they aren’t the same in all people who have it. But doctors look for specific things:
- Joint pain/swelling/stiffness, especially in small joints like your wrists, hands, or feet
- Discomfort for at least 6 weeks
- Morning stiffness that lasts at least 30 minutes
- Loss of appetite
There isn’t a single test that gives doctors a clear answer. And in the early stages, RA can resemble other diseases like:
- Sjogren’s syndrome
- Psoriatic arthritis
- Lyme arthritis
That’s why your doctor will rely on many things to help pinpoint the cause of your pain and other symptoms.
Lab and Blood Tests for RA
Here are some of the things you can expect to happen at your appointment if the doctor thinks you have RA.
Personal and family medical history: Your doctor will ask about your past and your relatives’. If someone in your family tree has RA, you may be more likely to have the disease.
Physical exam: The doctor will check your joints for swelling, tenderness, and range of motion. RA tends to strike several joints.
Antibody blood tests: Doctors look for certain proteins that show up in your blood when you have RA. These proteins mistakenly target healthy cells and kick off the inflammation process. So a high or positive test result means inflammation is in your body.
- Rheumatoid factor (RF): high levels (over 20 u/ml)
- Anti-CCP (anti-cyclic citrullinated peptide): high levels (over 20 u/ml)
- ANA, or antinuclear antibodies: the results are positive or negative
Not all people with RA have these proteins.
Other blood tests: Besides RF and anti-CCP, other blood tests could include:
Complete blood count: It helps your doctor find anemia (low red blood cells), which is common in RA. It looks for four things:
- White blood cells 4.8-10.8
- Red blood cells 4.7-6.1
- Hemoglobin 14.0-18.0
- Hematocrit 42-52
- Platelets 150-450
Erythrocyte sedimentation rate: This measures how fast your red blood cells clump and fall to the bottom of a glass tube within an hour. Your doctor might call it a sed rate.
Normal ranges are:
- Men younger than 50: 0-15 mm/h
- Men older than 50: 0-20 mm/h
- Women younger than 50: 0-20 mm/h
- Women older than 50: 0-30 mm/h
C-reactive protein: This test measures levels of a protein your liver makes when inflammation is present. Results vary from person to person and lab to lab, but most of the time a normal result is less than 1.0.
Imaging tests: These can help your doctor judge how severe your disease is and track its progress over time.
- X-rays can show whether (and how much) joint damage you have, though damage may not show up early on.
- Magnetic resonance imaging (MRI) and ultrasound give a more detailed picture of your joints. These scans aren’t normally used to diagnose RA, but they can help doctors find it early.
What Else Could It Be?
When a doctor thinks about how likely you are to have one disease over another, or over several others, this is called a differential diagnosis. There are many conditions your doctor may consider besides RA, and besides other forms of autoimmune arthritis:
Viral arthritis: Rubella, parvovirus, and hepatitis B and C can lead to short-term arthritis symptoms that resemble RA.
Palindromic rheumatism: Periodic joint inflammation that may lead to RA, lupus, and similar diseases
Polymyalgia rheumatica: This is more common over age 50, generally less painful than RA, and associated more with shoulders and hips.
Don’t panic if you learn you have rheumatoid arthritis. While there is no cure, people are living better now with RA than ever before. Your doctor will talk to you about all the ways you can treat the disease and manage your symptoms.
Medicines: There are several types: nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying drugs.
Lower the stress on your joints: Lose weight or stay at a healthy weight. Get some rest, but not too much — moderate activity helps, too. Use canes and walkers to take pressure off your lower body.
Surgery: If you have major joint damage over time, you may want to talk to your doctor about surgery. Total joint replacements of the knee, hip, wrist, and elbow can help. Less serious surgeries may also be good options.
- Johns Hopkins Arthritis Center: “Rheumatoid Arthritis,” “Rheumatoid Arthritis Signs and Symptoms,” “Rheumatoid Arthritis Treatment.”
- Arthritis Foundation: “Rheumatoid Arthritis Diagnosis,” “Rheumatoid Arthritis Symptoms.”
- UpToDate: “Diagnosis and differential diagnosis of rheumatoid arthritis.”
- Mayo Clinic: “Rheumatoid Arthritis: Diagnosis,” “Rheumatoid Arthritis: Symptoms and causes.”