Connect with others who understand.

sign up log in
About myRAteam

Rheumatoid Arthritis – The Path to Diagnosis

Updated on June 08, 2020

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?

RA – 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. The 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 RA, 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?

Non-juvenile 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

References

Kelly leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

A myRAteam Member said:

we are all in the same boat, we get it! Stay strong

posted 5 days ago

hug

Recent articles

Rheumatoid arthritis in hands and fingers what you need to know
Article written by Laurie Berger Rheumatoid arthritis (RA), a chronic inflammatory disease, can...

Rheumatoid Arthritis in Hands and Fingers: What You Need to Know

Article written by Laurie Berger Rheumatoid arthritis (RA), a chronic inflammatory disease, can...
Your answers  the worst ra advice
We asked and you answered! We posted this question: What bits of "advice" do you wish people...

Your Answers: The Worst RA Advice (Infographic)

We asked and you answered! We posted this question: What bits of "advice" do you wish people...
Rheumatoid arthritis in feet and ankles  symptoms and treatments
Article written by Laurie Berger When rheumatoid arthritis (RA) attacks the feet and ankles, it...

Rheumatoid Arthritis in Feet and Ankles: Symptoms and Treatments

Article written by Laurie Berger When rheumatoid arthritis (RA) attacks the feet and ankles, it...
Mht ad normallife nobranding
Receiving a diagnosis of rheumatoid arthritis (RA) can inspire both relief and dread. It can be a...

Finding a New Normal: Living With Rheumatoid Arthritis

Receiving a diagnosis of rheumatoid arthritis (RA) can inspire both relief and dread. It can be a...
11 app icon ios
Our Provider Directory is a source of provider information submitted by members and providers. To...

How do I search for a provider?

Our Provider Directory is a source of provider information submitted by members and providers. To...
Mht myrateam carousel ra covid19 greaterrisk
Article written by Christine Sprunger Medically reviewed by Siddharth Tambar, MDThe past several...

Rheumatoid Arthritis and COVID-19: Are You At a Greater Risk?

Article written by Christine Sprunger Medically reviewed by Siddharth Tambar, MDThe past several...
11 app icon ios
When you select the small circle with the white ‘V’ to the right of posts, comments, questions,...

What does the little circle next to posts, comments, and questions do?

When you select the small circle with the white ‘V’ to the right of posts, comments, questions,...
Woman medicine pill2
by blogger and author Kate Mitchell It’s 9:41 on a Wednesday, and I have been trying to sleep for...

On Living with Acute Chronic Pain: Please Don’t Treat Me Like a Drug Addict!

by blogger and author Kate Mitchell It’s 9:41 on a Wednesday, and I have been trying to sleep for...
Ra and hydroxychloroquine %28plaquenil%29 shortages
Article written by Kelly Crumrin Medically reviewed by Jeffrey A. Sparks, M.D., M.M.Sc....

Rheumatoid Arthritis and Hydroxychloroquine (Plaquenil) Shortages

Article written by Kelly Crumrin Medically reviewed by Jeffrey A. Sparks, M.D., M.M.Sc....
Rheumatoid arthritis and itching
Are you experiencing persistent and painful itching with rheumatoid arthritis (RA)? You’re not...

Rheumatoid Arthritis and Itching

Are you experiencing persistent and painful itching with rheumatoid arthritis (RA)? You’re not...
myRAteam My rheumatoid arthritis Team

Two Ways to Get Started with myRAteam

Become a Member

Connect with others who are living with rheumatoid arthritis. Get members only access to emotional support, advice, treatment insights, and more.

sign up

Become a Subscriber

Get the latest articles about rheumatoid arthritis sent to your inbox.

Not now, thanks

Privacy policy
myRAteam My rheumatoid arthritis Team

Thank you for signing up.

close