Rheumatoid arthritis (RA) can be a challenge to diagnose as many symptoms are confused with other health conditions and there is no single test to confirm an RA diagnosis
Since there is no single test, like a blood test or physical finding to confirm an RA diagnosis, your primary care physician will likely refer you to a rheumatologist if she suspects RA based on your signs and symptoms.
Be Patient. It can take time to get an RA Diagnosis.
According to this study , the median time from symptom onset to diagnosis of RA was 36 weeks. 40% of patients in the study were diagnosed more than 6 months after symptom onset. Patients with progressive disease and positive rheumatoid factor on the initial test experienced a shorter diagnosis time.
Steps to getting an RA diagnosis
To make a proper diagnosis, the rheumatologist will likely ask questions about personal and family medical history, perform a physical exam and order diagnostic tests.
Medical History
The doctor will ask about personal and family medical history as well as recent and current symptoms (pain, tenderness, stiffness, difficulty moving).
Physical Exam
During the physical exam she will look for features of RA such as
- tender, warm, swollen joints
- Symmetrical pattern – RA tends to affect joints on both sides of the body.
- Stiffness
- Fatigue, ocasional fevers, a loss of energy
Blood Tests
She might will likely order a blood test to check for inflammation levels and look for antibodies linked with RA.
Inflammation Levels
She will be looks at your ESR and CRP. ESR or “sed rate” is your Erythrocyte sedimentation rate and CRP is your C-reactive protein level. Both are markers of inflammation, however A high ESR or CRP is not specific to RA. However when taken in combination with other clues, can be used to help make an RA diagnosis.
Antibodies
When looking at antibodies, she is likely looking at RF and anti-CCP. RF, short for, Rheumatoid factor is an antibody (blood protein) found in about 80 percent of people with RA during the course of their disease. She just can’t look at RF since it can occur in other diseases. That’s where anti-CCP comes in. anti-CCP or anti-cyclic citrullinated peptide is a different antibody that occurs primarily in patients with RA. So why not just look at that? Anti-CCP antibodies are found in only 60 to 70 percent of people with RA and can exist even before symptoms start. So you have to look at both together. (You can start to see why getting an RA diagnosis is so hard)
Imaging Tests
Finally, she will likely want to take a look for joint damage using an X-ray, ultrasound or MRI. Again, complicating things is that fact that if imaging tests don’t show joint damage that doesn’t rule out RA. It may mean that the disease is in an early stage and hasn’t damaged the joints yet.
