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How Is Rheumatoid Arthritis Diagnosed?
Diagnosing rheumatoid arthritis (RA) involves a few steps. Learn about the tests and exams that are used.

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What is rheumatoid arthritis?

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, and weakened tendons and ligaments.

The areas of the body that RA can affect include:

  • skin
  • eyes
  • lungs
  • heart
  • blood vessels

Early stage symptoms of RA can look like symptoms of other conditions. Since there’s no single test for RA, a diagnosis takes time to confirm.

Severe RA can lead to physical disabilities, pain, and disfigurement. So diagnosing RA in its early stages is the best way to treat and prevent the disease from worsening.

If you think you may have RA, consult a doctor immediately.

What are the symptoms of rheumatoid arthritis?

In the early stage 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, other joints will become affected.

A distinguishing symptom of RA is that the joint involvement is symmetrical.

RA is progressive and there is a risk of joint damage and physical disability. It’s important to recognize your symptoms. Your doctor may ask about them when diagnosing RA.

Symptoms of RA include:

  • painful joints
  • swollen joints
  • joint stiffness
  • fatigue
  • weight loss

It's important to tell your doctor about joint pain and swelling that doesn’t improve.

How is rheumatoid arthritis diagnosed?

RA usually takes time to diagnose. In the early stages, the symptoms can look like symptoms of other conditions like lupus or connective tissue disease. RA symptoms also come and go, so you may feel better before a flare-up happens again.

Your doctor may prescribe medication based on your history and the initial physical findings. But it’s important for you to keep regular follow-up visits.

Your doctor will ask about your symptoms, medical history, and risk factors. For testing, your doctor will order blood samples and perform a physical exam. A physical exam involves checking your joints for swelling, tenderness, and range of motion.

If you or your doctor thinks you might have RA, you will want to see a rheumatologist. A rheumatologist specializes in diagnosing and managing RA, and finding a treatment plan to address your needs.

Diagnostic criteria

The current diagnostic criteria for RA require at least six points on a classification scale, and one positive, confirmed blood test, according to the American College of Rheumatology.

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-CPP) (up to three points)
  • positive C-reactive protein (CRP) or erythrocyte sedimentation tests (one point)
  • symptoms lasting longer than six weeks (one point)

Blood tests for rheumatoid arthritis

RA is an autoimmune disease. Several different blood tests can detect immune system changes, or antibodies that may attack the joints and other organs. Others measure inflammation or overall immune system function.

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 also no single test to confirm RA, so your doctor may order multiple tests.

Rheumatoid factor test

Most people with RA have high levels of rheumatoid factor (RF), according to the Mayo Clinic. RF is a protein that your body’s immune system produces. It can attack the healthy tissue in your body.

Higher levels of RF also mean more severe symptoms and faster progression. But RF tests can’t be used to diagnose RA alone. Some people with RA test negative for RF, a 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. According to one study, the anti-CCP test is useful for early diagnosis. It can identify people who are more likely to develop severe and irreversible damage due to RA.

If you test positive for anti-CPP, 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-CPP. However, people with RA may test negative for anti-CPP. To confirm RA, your doctor will look at this test result in combination with other tests.

Antinuclear antibody test (ANA)

ANA tests are a general indicator of autoimmune disease. A positive ANA test means that your body is producing antibodies. An elevated 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.

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 a 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.

Other tests for rheumatoid arthritis

In addition to blood tests for RA, other tests can also be used to 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 scans to assess the level of damage to the cartilage, tendons, and bones. It can also help determine the best method of treatment.

However, X-rays can only be used to 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 also 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 during RA.

MRIs can detect inflammation due to RA far earlier than an X-ray. However, they are not widely used in diagnosis.

Next steps for rheumatoid arthritis

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, lungs, and blood vessels.

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 to reduce inflammation.

Drugs to help slow the progression of RA include DMARDs, or disease-modifying antirheumatic drugs, like methotrexate, Arava, and hydroxychloroquine.

Other drugs used to treat RA include biologic agents, drugs made inside living cells, like abatacept and adalimumab (Humira). These are often prescribed if DMARDs don’t work.

Average price of drugs to treat RA

Your doctor may recommend surgery if medication doesn’t improve your condition. A total joint replacement or joint fusion can stabilize and realign affected joints.

Alternative treatments

Physical therapy can be an effective treatment to improve joint flexibility. And fish oil supplements and herbal medications may provide relief from pain and inflammation. Talk to your doctor before trying something new.

RA may be a lifelong condition, but you can still live a healthy, active life after diagnosis. You’ll find the best outcome and chance of remission when you stay active and follow the treatment plan recommended by your doctor.

Written by: The Healthline Editorial Team and Valencia Higuera
Edited by:
Medically Reviewed by: [Ljava.lang.Object;@40da97be
Published: Sep 3, 2014
Published By: Healthline Networks, Inc.
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