Connect with others who understand.

sign up log in
About myRAteam

Rheumatoid Arthritis – The Path to Diagnosis

Posted on August 01, 2018
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Kelly Crumrin

In rheumatoid arthritis (RA), joint inflammation is caused by the immune system mistakenly attacking the synovium, a membrane that lines and lubricates the inside of joints. There is no one test that is conclusive for a diagnosis of RA. RA is diagnosed through a combination of a physical examination, family history, blood tests, and imaging scans. In most cases, RA is diagnosed by a rheumatologist, or specialist in musculoskeletal and autoimmune diseases.

How Is Rheumatoid Arthritis Diagnosed?

Rheumatoid arthritis — especially when the symptoms are mild — is often misdiagnosed. Joint pain in RA can resemble other chronic diseases including lupus, ankylosing spondylitis, psoriatic arthritis, Sjögren’s syndrome, gout, and osteoarthritis. A doctor carefully considers many different test results and which joint diseases they may indicate before concluding that RA is the correct diagnosis or ruling it out.

The American College of Rheumatology has established classification criteria for diagnosing RA. Criteria include an assessment of which joints (and how many) are involved, how long symptoms have been present, and results from certain blood tests. Based on these criteria, a rheumatologist may or may not diagnose "definite RA."

Physical Exam and Family History

Typically, the rheumatologist will start by examining your joints to check for signs of disease activity, such as swelling, rheumatoid nodules, redness, warmth, and symmetry. In RA, symptoms are symmetrical, appearing on the same joints on both sides of the body. You may be asked about what times of day you experience symptoms — morning stiffness is common in RA. Mobility limitations and associated pain will also be assessed. You may also be asked about family medical history of RA or other autoimmune diseases. Having relatives with autoimmune conditions may increase your risk factors for developing RA.

Imaging

Diagnosis may also involve blood tests or imaging procedures such as X-rays, ultrasound, or magnetic resonance imaging (MRI) scans. Scans allow the doctor to check for joint damage during diagnosis, and later measure how the disease progresses over time. Ultrasound and MRI were introduced more recently, and may aid in finding more subtle joint damage that can lead to an early diagnosis.

Lab Tests

Although no lab test is conclusive for rheumatoid arthritis, each can provide important clues that make an RA diagnosis seem more likely or help rule it out.

Blood tests look for specific proteins that act as biomarkers for RA and other inflammatory conditions. One biomarker, anti-cyclic citrullinated peptide (anti-CCP), is found in around 60 percent to 70 percent of people with RA. Anti-CCPs can appear in blood years before RA symptoms appear. Bloodwork may also look for rheumatoid factor (RF), although RF can also be found in people with conditions other than RA. The presence of anti-CCP and RF indicate an autoimmune reaction.

Furthermore, if you go on to be diagnosed with RA, whether or not you test positive for RF or anti-CCP provides criteria for being typed as seropositive (having RF or anti-CCP in the blood) or seronegative (not having RF or anti-CCP in the blood). Knowing your type of RA helps your doctor better predict your disease course and recommend the medication most likely to be effective in managing your RA.

Blood tests can also check overall levels of inflammation by examining erythrocyte sedimentation rate (ESR or “sed rate”) and C-reactive protein (CRP). At elevated levels, both ESR and CRP are considered signs of inflammation and can indicate RA or another inflammatory condition.

Similarly, anemia, or low red blood cell count, is another lab result often seen in people with RA.

If a diagnosis of rheumatoid arthritis is confirmed, your doctor may recommend additional testing to check the health of your lungs and cardiovascular system. In addition to painful joints, inflammation in RA can lead to increased risk for lung disease, heart disease, and vasculitis, or inflammation of the blood vessels. Eye disease and neurological problems are also common comorbidities (conditions that occur at the same time) of RA.

At What Age Does Rheumatoid Arthritis Start to Develop?

Adult rheumatoid arthritis typically develops between ages 30 and 60. When RA develops before the age of 17, it is referred to as juvenile arthritis. Read more about different types of RA.

Condition Guide

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

Related articles

Feeling stressed is common after being diagnosed with rheumatoid arthritis (RA), but you can find...

You’re Newly Diagnosed With Rheumatoid Arthritis: Now What?

Feeling stressed is common after being diagnosed with rheumatoid arthritis (RA), but you can find...
Physicians will use multiple blood tests, in addition to considering your medical and family...

Blood Tests for Diagnosing Rheumatoid Arthritis

Physicians will use multiple blood tests, in addition to considering your medical and family...
An X-ray can be an important baseline for diagnosing rheumatoid arthritis (RA) in its early...

Imaging Scans for Diagnosing Rheumatoid Arthritis

An X-ray can be an important baseline for diagnosing rheumatoid arthritis (RA) in its early...
It’s beneficial to get a diagnosis of rheumatoid arthritis (RA) as soon as possible after you...

The Importance of an Early Diagnosis

It’s beneficial to get a diagnosis of rheumatoid arthritis (RA) as soon as possible after you...
It can be a long and twisty path to a rheumatoid arthritis (RA) diagnosis. Misdiagnosis and the...

Diagnosis and RA

It can be a long and twisty path to a rheumatoid arthritis (RA) diagnosis. Misdiagnosis and the...

Recent articles

The U.S. Centers for Disease Control and Prevention (CDC) approved a second COVID-19 booster shot...

RA and Second COVID-19 Vaccine Booster Shots: What To Know

The U.S. Centers for Disease Control and Prevention (CDC) approved a second COVID-19 booster shot...
Rheumatoid arthritis (RA) is an inflammatory condition that occurs when the immune system attacks...

Scalp Health and RA: How To Manage Burning, Itching, and Hair Loss

Rheumatoid arthritis (RA) is an inflammatory condition that occurs when the immune system attacks...
Some people living with rheumatoid arthritis (RA) can develop eye complications due to the same...

Peripheral Ulcerative Keratitis and RA: What To Know

Some people living with rheumatoid arthritis (RA) can develop eye complications due to the same...
In rheumatoid arthritis (RA), the immune system mistakenly attacks the body, causing inflammation...

Can RA Medication Cause Nose and Mouth Sores?

In rheumatoid arthritis (RA), the immune system mistakenly attacks the body, causing inflammation...
If you’re living with rheumatoid arthritis (RA), you’re already aware of the impact the condition...

5 Ways To Get Involved With Rheumatoid Arthritis Awareness

If you’re living with rheumatoid arthritis (RA), you’re already aware of the impact the condition...
Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation in the joints and...

Is It Normal for Bones to Feel Cold and Painful With Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation in the joints and...
myRAteam My rheumatoid arthritis Team

Thank you for signing up.

close
myRAteam My rheumatoid arthritis Team

Want to stay up to date on the latest news and articles about RA?