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
The areas of the body that
RA can affect include:
- 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
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
- 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.
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
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)
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
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
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
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.
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
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
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
(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.
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.