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Diagnosis of Rheumatoid Arthritis
Your doctor may suspect rheumatoid arthritis (RA) based on your symptoms. Diagnosing RA can sometimes be difficult since there are several autoimmune disorders that have similar symptoms. Part of diagnosing RA is ruling out these other disorders.
The American College of Rheumatology and the European League Against Rheumatism have created a system for diagnosing RA. To start, symptoms need to be present for 6 weeks or more. The system then uses a 10-point scale assessing specific symptoms. The higher the score, the more likely RA is present.
Considered factors include:
The number of sore or swollen joints and any associated damage is considered. The areas affected may be a small joint ( hands or feet) or a large joint (shoulders, elbows, hips, knees, or ankles). Which joints are affected, how many joints are affected, and for how long they have been affected all help with the diagnosis.
Blood tests look for markers of RA. Specific substances that may be present with RA can be found in the blood. These include:
- Rheumatoid factor (RF)—An autoantibody (factor that marks own tissue for attack by immune system) associated with RA and other autoimmune disorders.
- Anti-citrullinated protein antibody—Autoantibodies that are directed to proteins.
- Erythrocyte sedimentation rate (ESR)—To measure inflammation. Faster ESR rates are seen in many different diseases.
- C-reactive protein (CRP)—A protein found in the blood that rises in response to inflammation.
Imaging tests assess the joints, surrounding structures, and any associated damage. Tests may include:
The following tests involve tissue samples. The samples are examined under a microscope. They can help diagnose RA (and other conditions).
- Synovial biopsy—Removing a piece of the synovial membrane that lines the joint capsule.
- Arthrocentesis (joint aspiration)—Removal of synovial fluid from the joint with a needle.
Handout on health: Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Rheumatic%5FDisease/default.asp. Updated August 2014. Accessed October 30, 2014.
Rheumatoid arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/conditions-treatments/disease-center/rheumatoid-arthritis. Accessed October 30, 2014.
Rheumatoid arthritis. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/musculoskeletal%5Fand%5Fconnective%5Ftissue%5Fdisorders/joint%5Fdisorders/rheumatoid%5Farthritis%5Fra.html. Updated May 2013. Accessed October 30, 2014.
Rheumatoid arthritis (RA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 10, 2014. Accessed October 30, 2014.
Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011;84(11):1245-1252.
9/10/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Aletaha D, Neogi T, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580-1588.
4/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed April 24, 2014.
- Reviewer: Michael Woods, MD
- Review Date: 05/2014
- Update Date: 10/30/2014