Rheumatoid arthritis (RA) is a type of autoimmune disease where the body’s immune system attacks the lining of the joints. This leads to painful joints, as well as weakened tendons and ligaments.
RA can also affect other areas of the body, including the:
- bone marrow
- blood vessels
In the early stages of RA, the condition may only affect one or several joints. These are usually the small joints of the hands and feet. As RA progresses, it starts to affect other joints.
Symptoms of RA include:
- painful joints
- swollen joints
- joint stiffness
- weight loss
Severe RA can change the shape and position of joints, leading to malalignment, functional limitations, and physical disabilities. Diagnosing RA in its early stages is the best way to treat the disease and prevent it from worsening.
Since there’s no single test for RA, a diagnosis takes time to confirm. If you think you may have RA, consult a doctor immediately.
RA usually takes time to diagnose. In the early stages, the symptoms can look like symptoms of other conditions like lupus or other connective tissue diseases.
RA symptoms also come and go, so you may feel better between flare-ups.
Your doctor may prescribe medication based on your history, initial physical findings, and laboratory confirmation. It’s important, however, for you to make regular follow-up visits.
Your doctor will ask about your symptoms, medical history, and risk factors. A detailed physical examination, checking your joints for swelling, tenderness, and range of motion, will be performed and blood tests will be ordered.
If you or your doctor thinks you might have RA, you’ll want to see a rheumatologist. A rheumatologist specializes in diagnosing and managing RA, and finding a treatment plan to address your needs.
The American College of Rheumatology’s most current, approved classification criteria for RA was developed in 2010.
The classification criteria may help with diagnosis, but is mainly intended to identify RA severity for use in studies. This means that your doctor could diagnose RA even if you don’t meet the classification criteria.
The 2010 criteria for RA require at least six points on a classification scale, including one positive, confirmed blood test. To get six points, a person must have:
- symptoms affecting one or more joints (up to five points)
- positive test results on a blood test for either rheumatoid factor (RF) or anticitrullinated protein antibody (anti-CCP) (up to three points)
- positive C-reactive protein (CRP) or erythrocyte sedimentation tests (one point)
- symptoms lasting longer than 6 weeks (one point)
RA is an autoimmune disease. Several different blood tests can detect immune system changes or antibodies that may attack the joints and other organs. Other tests are used to measure the presence and degree of inflammation.
For blood tests, your doctor will draw a small sample from a vein. The sample is then sent to a lab for testing. There’s no single test to confirm RA, so your doctor may order multiple tests.
Rheumatoid factor test
Many people with RA have high levels of an antibody called rheumatoid factor (RF). RF is a protein that your body’s immune system produces. It can attack the healthy tissue in your body.
RF tests can’t be used to diagnose RA alone. Some people with RA test negative for RF, while other people without RA may test positive for RF.
Anticitrullinated protein antibody test (anti-CCP)
An anti-CCP test, also known as ACPA, tests for an antibody associated with RA.
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If you test positive for anti-CCP antibodies, there’s a good chance you have RA. A positive test also indicates that RA is likely to progress more rapidly.
People without RA almost never test positive for anti-CCP. However, people with RA may test negative for anti-CCP.
To confirm RA, your doctor will look at this test result in combination with other tests and clinical findings.
Antinuclear antibody test (ANA)
ANA tests are a general indicator of autoimmune disease.
A positive ANA test means that your body is producing antibodies that are attacking normal cells instead of foreign organisms. A high level of this antibody could mean that your body’s immune system is attacking itself.
Since RA is an autoimmune disease, many people with RA have positive ANA tests. However, a positive test doesn’t mean you have RA.
Many people have positive, low-level ANA tests without clinical evidence of RA.
Complete blood count (CBC)
This test counts the number of red blood cells, white blood cells, and platelets in your blood.
Red blood cells carry oxygen throughout the body. A low number can indicate anemia and is commonly found in people with RA.
A high number of white blood cells, which fight infection, may point to an immune system disorder or inflammation. This could suggest RA.
The CBC also measures the amount of hemoglobin, a protein in your blood that carries oxygen, and hematocrit, the volume of red blood cells in your blood. RA could result in a low hematocrit level.
Erythrocyte sedimentation rate (sed rate)
Also called ESR, the sed rate test checks for inflammation. The lab will look at the sed rate, which measures how quickly your red blood cells clump and sink to the bottom of the test tube.
There’s typically a direct correlation between the level of the sed rate and the degree of inflammation.
C-reactive protein test (CRP)
CRP is another test used to look for inflammation. CRP is produced in the liver when there’s severe inflammation or infection in the body. High levels of CRP can indicate inflammation in the joints.
C-reactive protein levels change more quickly than sed rates. That’s why this test is sometimes used to measure the effectiveness of RA medications, in addition to diagnosing RA.
In addition to blood tests for RA, other tests can also detect damage caused by the disease.
X-rays can be used to take images of joints affected by RA.
Your doctor will look at these images to assess the level of damage to the cartilage, tendons, and bones. This evaluation can also help determine the best method of treatment.
However, X-rays can only detect more advanced RA. Early soft tissue inflammation doesn’t show up on the scans. A series of X-rays over a period of weeks or months can help monitor RA progression.
Magnetic resonance imaging (MRI)
MRIs use a powerful magnetic field to take a picture of the inside of the body. Unlike X-rays, MRIs can create images of soft tissues.
These images are used to look for inflammation of the synovium. The synovium is the membrane lining the joints. It’s what the immune system attacks in RA.
MRIs can detect inflammation due to RA far earlier than an X-ray. However, they’re not widely used to diagnose the disease.
Early stage symptoms of RA can look like symptoms of other conditions. These conditions include:
- other types of arthritis, such as osteoarthritis
- Lyme disease
- Sjogren’s syndrome
A distinguishing symptom of RA is that the joint involvement is often symmetrical. Your joints may also feel stiffer in the mornings if you have RA.
Your doctor will use tests and other information about your symptoms to help diagnose RA, document other diseases that can be associated with RA (such as Sjogren’s syndrome), and rule out other conditions.
A diagnosis of RA is only the beginning. RA is a lifelong condition that primarily affects the joints, but it can also affect other organs such as the eyes, skin, and lungs.
Treatment is most effective in the early stages and can help delay the progression of RA.
See your doctor immediately if you suspect you may have RA. They can recommend treatment options to help manage your symptoms.
You may be able to manage the joint pain of RA with over-the-counter (OTC) anti-inflammatory medications like ibuprofen. Your doctor may also suggest a corticosteroid medication, like prednisone, to reduce inflammation.
Drugs to help slow the progression of RA include disease-modifying antirheumatic drugs (DMARDs). DMARDs are usually prescribed right after diagnosis, and include:
- methotrexate (Trexall)
- leflunomide (Arava)
- sulfasalazine (Azulfidine)
- hydroxychloroquine (Plaquenil)
Other drugs used to treat RA include biologic agents — drugs made inside living cells. These include abatacept (Orencia) and adalimumab (Humira). These are often prescribed if DMARDs don’t work.
Your doctor may recommend surgery if joint involvement has resulted in deformity, loss of function or intractable pain, causing limitation of motion and progressive debility.
A total joint replacement or joint fusion can stabilize and realign affected joints.
Physical therapy can be an effective treatment to improve joint flexibility. Low-impact exercises, like walking or swimming, can also benefit your joints and your overall health.
Fish oil supplements and herbal medications may help reduce pain and inflammation. Talk to your doctor before trying something new since supplements aren’t regulated and may interfere with some approved medications.
Other complementary treatments, like massage, may also help with RA. A small
More research needs to be done on alternative treatments for RA.
RA may be a lifelong condition, but you can still live a healthy, active life after diagnosis. The right medications may even be able to control your symptoms entirely.
Although there’s no cure for RA, early diagnosis and treatment can help keep RA from getting worse. If you have joint pain and swelling that doesn’t improve, it’s important to tell your doctor.
You’ll find the best outcome and chance of remission are possible when you stay active and follow the treatment plan recommended by your doctor.