Early diagnosis and prompt treatment of rheumatoid arthritis is extremely important. Early intervention often means the difference between a relatively normal lifestyle and a life encumbered with serious disability. Many people, however, don't realize the importance of early intervention. The Arthritis Foundation estimates that the average person waits four years before seeking medical help for arthritis symptoms. Many people ignore the signs of RA, believing they are normal manifestations of aging. This is unfortunate because most of the joint damage from RA occurs during the first two years.

Sixty percent of people who were diagnosed with RA ten years or more ago are no longer able to work. Today, patients who are diagnosed quickly and begin treatment early have a brighter future. Early treatment can stay the progression of the disease, eliminate the need for surgery later, and even prolong life expectancy. Ideally, diagnosis should be made within the first three to four months after symptoms begin.

Anyone experiencing these symptoms for more than two weeks should visit a physician:

Stiffness in many joints upon awakening in the morning, lasting for hours

Swelling, tenderness and limited motion of joints

There is no one test that can conclusively determine whether a person has rheumatoid arthritis. Diagnosis is based on medical history, a physical examination, laboratory tests and radiology results.

Medical History

Assessment begins with obtaining patient information. Patients are asked about the severity of their symptoms and when they began. An accurate description of pain, morning stiffness, fatigue and joint function is important not only for diagnosis, but also to provide a baseline for comparison later.

Physical Examination

The hands, wrists, feet, neck, temporo-mandibular joint, elbows, shoulders, knees, and ankles will be examined for warmth, swelling and limitation of motion. The doctor will also look for rheumatoid nodules, especially around the elbows.

Laboratory Tests

The results of several tests may be used along with other findings to help confirm a diagnosis. Tests may include:

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 anemia.

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 these abnormalities.

Radiology

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 over time.

A diagnosis of RA usually includes four of the following seven symptoms. The first four must have persisted for at least six weeks and have been observed by a physician:

Morning stiffness that lasts an hour or more

Swelling of soft tissue around at least three joints

Swelling of the soft tissue of the hand and/or wrist joints

Symmetrical swelling of soft tissues

Subcutaneous nodules

Serum rheumatoid factor

Erosions and/or osteopenia (mild thinning of the bone) in hand or wrist joints

The inexperienced clinician may have difficulty diagnosing RA. The main reasons are:

Variable disease patterns. RA symptoms can differ from person to person, and can vary in severity. In addition, only a few symptoms may appear at first.

RA resembles other diseases. RA is often confused with lupus, osteoarthritis, and gout. In addition, there are dozens of other conditions that include joint pain and fever which may be confused with RA. Some of these are viral arthritis, rheumatic fever and hepatitis C.

Inconclusive tests. In early RA, blood tests and x-rays may be normal.

Physician inexperience. General practice physicians often receive little rheumatic disease instruction in medical school or during clinical training. A lack of experience with RA can complicate diagnosis.

To assure accurate diagnosis, primary care doctors often refer patients to rheumatologists, physicians who specialize in the treatment of arthritis disorders. A rheumatologist should also manage or co-manage long-term follow-up.

References

First published September 1, 1999
Last updated December 16, 2002
Copyright © 1999 Accordant Health Services, Inc. All Rights Reserved.

Or Find More On:

Back to top of page