How does a doctor diagnose rheumatoid arthritis?

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The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) created a classification system in 2010 to diagnose RA.

The system uses four categories to score symptoms. Doctors add up points within each category, and the total score determines whether a person has RA. A score of six or more classifies someone as having RA.

Doctors look at the number of joints someone has that are tender or swollen. They consider if they are large joints such as the shoulders, hips, and knees, or small joints such as the fingers, thumb, and wrist joints. They may also use imaging tests to examine joint damage.

A type of blood testing called serology can check for certain antibodies in the blood, which could show if someone has RA. Two of these antibodies are anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF).

Doctors also test for markers of inflammation, called acute phase reactants. Increases in two markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), indicate higher levels of inflammation.

The following table shows the classification system:

Since there is no single test to diagnose RA, doctors use a combination of investigations. After taking a complete medical history and physical examination and excluding other causes, doctors may use the following tests:

Blood tests

Doctors may take a range of blood tests to check for specific antibodies and inflammatory markers which can indicate RA. They include:

• Complete blood count: A complete blood count looks at the various blood cells circulating. It checks the red blood cell and hemoglobin levels. Hemoglobin is an iron-rich protein that carries oxygen around the body. If someone has low iron levels, they may have anemia, which is a common RA symptom.
• Erythrocyte sedimentation rate (ESR): Doctors place a blood sample into a test tube and time how long the red blood cells take to sink. If the cells clump they drop faster than expected, which can signal inflammation.
• C-reactive protein (CRP): The liver makes this protein, which typically increases in line with inflammation.
• Rheumatoid factor (RF): Roughly half of the people with RA test positive for RF antibody in their blood. However, about 1 in 20 people who test positive for RF do not have RA.
• Anti-CCP: People who test positive for the anti-CCP antibody are more likely to have RA.

Imaging tests

Doctors can use imaging tests to check for inflammation, damage to the joints, and how far the disease has progressed. These can include:

• X-rays: These can provide an image of any physical changes to the joints.
• MRI scans: These use magnetic fields and radio waves to create an image of the joints.
• Ultrasound: This uses high-frequency sound waves to form an image of the joints.

The American College of Rheumatology provides the following information a person should bring to or be prepared to provide at their first rheumatologist appointment:

• their medical history
• any relevant family medical history
• a list of any medications or supplements the person takes or has taken previously

People should also prepare a detailed record of their symptoms, such as:

• when the symptoms started
• where the symptoms were
• how long the symptoms have lasted
• any triggers they have noted

When people provide their rheumatologist this detail it can help with the diagnosis. People should also take along any test results, such as blood or imaging tests, if they have them.

People may feel more confident about an upcoming medical appointment if they make a list of questions to ask the doctor before their visit. People with a new diagnosis of RA may want to ask:

• Is RA causing all of the symptoms, or are any other conditions involved?
• What are the treatment options?
• Can home remedies help ease symptoms?
• What are the possible side effects or risks of medications and treatments?
• Are there any exercise and physical activity recommendations?
• How can a person manage flare-ups?
• Is over-the-counter pain relief medication, such as acetaminophen, safe to take?
• Is it safe to take any supplements?
• Are there any alternative treatments, such as physical therapy and acupuncture, to try?
• How will RA and medications affect the immune system, and how can a person manage any infections?
• How will doctors monitor RA and medications?
• What are the goals of treatment?

People may want to bring a friend or family member along to take notes during the appointment and provide extra support.

People may use a combination of treatments to help manage RA symptoms and help prevent it from progressing. Treatments include:

Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs can help relieve symptoms and slow joint damage. They can significantly improve pain, swelling, and quality of life for most people with RA. However, DMARDs can affect the liver and bone marrow, so people taking these medications need regular blood tests to check their liver and blood cell health.

Corticosteroids

Some people find that corticosteroids can provide short-term pain relief. However, individuals should exercise caution because long-term use can cause weight gain, osteoporosis, cataracts, and thinning skin.

Biologics

Biologics work to block the immune system from sending signals that cause inflammation. Intravenous biologics may sometimes cause headaches, fever, and body aches, which is known as an infusion reaction.

Assistive devices

People may find certain tools can help make everyday tasks easier. For example, canes and walkers can help reduce stress on joints.

Surgery

If other treatments do not help, people may need to consider surgery. According to the John Hopkins Arthritis Center, surgical options include a synovectomy or a total joint replacement.

During a synovectomy, the surgeon removes the inflamed lining of joints, called the synovium. It may only provide temporary relief but can help in treating RA of the wrist.

Total replacements of the knee, hip, wrist, and elbow joints are highly effective treatments. Knuckle replacement can also decrease pain and increase function.

Surgery may have a risk of complications, such as infections, bleeding, or blood clots.

Home remedies

The Arthritis Foundation recommends the following home remedies for relieving RA symptoms:

• regular, low-impact exercise such as walking and stretching
• stress reduction through mindful activities, deep breathing, and meditation
• hot compresses to soothe stiff or aching joints
• cold compresses to numb pain and reduce inflammation

Alternative therapies

People can take supplements such as turmeric or curcumin and omega-3 fish oil. These natural options may effectively reduce the RA pain and stiffness that someone may experience in the mornings.

Supplements can have side effects or interact with other medication, so people should talk to their doctor before taking them.

Coping and support

Living with RA may feel overwhelming, and most people benefit from the support of others to help them cope with an RA diagnosis. People can try the following tips to help them manage life with RA:

• take regular rest breaks
• make a treatment plan to follow to feel more in control
• talk to family and friends about how RA makes people feel physically and mentally
• find a local support group or community of people with RA
• do activities they enjoy

Doctors can find rheumatoid arthritis challenging to diagnose because symptoms can overlap with other conditions. They need to use a combination of blood and imaging tests, medical history, symptoms, and a physical exam to diagnose RA.

People can help their doctor make a diagnosis by keeping a detailed record of any symptoms. Additionally, an individual may feel better prepared for a doctor’s appointment if they first consider and write down any questions or concerns.

Although RA has no cure, a combination of treatments can help people manage their symptoms and slow down the disease progression.