Rheumatoid Arthritis Diagnosis
RA can begin very gradually, or it can strike quickly. The first symptoms are pain,
swelling, and stiffness in the joints. The most commonly involved joints include hands,
feet, wrists, elbows, and ankles, although other joints may also be involved. The joints
are affected in a symmetrical fashion. This means that if the right wrist is involved, the
left wrist is also involved. Patients frequently experience painful joint stiffness when
they first get up in the morning, lasting for perhaps an hour. Over time, the joints
become deformed. The joints may be difficult to straighten, and affected fingers and toes
may be permanently bent (flexed). The hands and feet may curve outward in an abnormal way.
Many patients also notice increased fatigue, loss of appetite, weight loss, and
sometimes fever. Rheumatoid nodules are bumps that appear under the skin around the joints
and on the top of the arms and legs. These nodules can also occur in the tissue covering
the outside of the lungs and lining the chest cavity (pleura), and in the tissue covering
the brain and spinal cord (meninges). Lung involvement may cause shortness of breath and
is seen more in men. Vasculitis (inflammation of the blood vessels) may interfere with
blood circulation. This can result in irritated pits (ulcers) in the skin, tissue death
(gangrene), and interference with nerve functioning that causes numbness and tingling.
Rheumatoid Arthritis Diagnosis - test
- Rheumatoid Factor
This is the most useful diagnostic test because 80% of people with RA
eventually show a high concentration of rheumatoid factor in their
blood. Rheumatoid factor is an antibody produced against immunoglobulin
G. (Antibodies are proteins the body manufactures to fight off foreign
substances). However, since not all people with RA have rheumatoid
factor, and because other diseases can test positive for it, this test
by itself is not conclusive.
- Sed Rate the sed rate or ESR (erythrocyte sedimentation rate) measures how fast
red blood cells (erythrocytes) fall to the bottom of a glass tube filled
with the patient's blood. The higher the sed rate, the more inflammation
the patient has. Elevated sed rates are usually found with RA, but they
also occur with other conditions.
- Hemocrit A hemocrit measures of the volume of erythrocytes in the blood. Red
blood cells carry oxygen throughout the body via a pigment called
hemoglobin. A low hemocrit means that a person has too few red cells in
the blood, and therefore too little hemoglobin, resulting in an
insufficient supply of oxygen to the cells. This is called anemia.
Anemia is common with RA. Many other conditions, however, can also cause
- Synovial fluid analysis Synovial fluid is obtained through arthrocentesis. In this procedure
fluid is withdrawn from a joint and analyzed. Active inflammation makes
synovial fluid cloudy and abnormally thin, with higher than normal
protein and white blood cells. Conditions other than RA can produce
- Citrulline antibody Citrulline antibody is present in most
patients with rheumatoid arthritis. It is used in the diagnosis of
rheumatoid arthritis when evaluating patients with unexplained joint
inflammation. A test for citrulline antibodies is most helpful in
looking for the cause of previously undiagnosed inflammatory arthritis
when the traditional blood test for rheumatoid arthritis, rheumatoid
factor, is not present. When the citrulline antibody is found in a
patient's blood, there is a 90-95% likelihood that the patient has
- Antinuclear Antibodies (ANA) An antinuclear antibody
(ANA) test measures the amount and pattern of antibodies in your blood
that work against your own body (autoimmune).
- C-Reactive Protein (CRP) This is a type of protein that shows
up in your blood during episodes of acute inflammation or
infection. A high result serves as a general indication of acute
inflammation. It must be noted that even in known cases of inflammatory
disease, such as rheumatoid arthritis and lupus, a low CRP level is
possible, and is not indicative of no inflammation.
- Anti-CCP antibodies Anti-CCP antibodies are potentially
important surrogate markers for diagnosis and prognosis in rheumatoid
arthritis (RA), because they:
- are as sensitive as, and more specific than, IgM rheumatoid
factors (RF) in early and fully established disease
- may predict the eventual development into RA when found in
- are a marker of erosive disease in RA
- may be detected in healthy individuals years before onset of
X-rays can reveal cartilage damage that causes joint space narrowing.
They can also show bone erosion and localized osteoporosis. In the early
stages of RA, x-rays are not very useful since joint damage is usually
not present. When several joints are involved, however, a physician may
elect to x-ray one joint (usually hands) as a baseline for comparison
More detailed information about Rheumatoid Arthritis Diagnosis
There are no tests available that can absolutely diagnose RA. Instead, a number of
tests exist that can suggest the diagnosis of RA. Blood tests include a special test of
red blood cells (called erythrocyte sedimentation rate), which is positive in nearly 100%
of patients with RA. However, this test is also positive in a variety of other diseases.
Tests for anemia are usually positive in patients with RA, but can also be positive in
many other unrelated diseases. Rheumatoid factor is an autoantibody found in about 66% of
patients with RA. However, it is also found in about 5% of all healthy people and in
10-20% of healthy people over the age of 65. Rheumatoid factor is also positive in a large
number of other autoimmune diseases and other infectious diseases.
A long, thin needle can be inserted into a synovial joint to withdraw a sample of the
synovial fluid for examination. In RA, this fluid has certain characteristics that
indicate active inflammation. The fluid will be cloudy, relatively thinner than usual,
with increased protein and decreased or normal glucose. It will also contain a higher than
normal number of white blood cells. While these findings suggest inflammatory arthritis,
they are not specific to RA.