Diagnosis

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Rheumatoid arthritis (RA) can be difficult to diagnose in its initial stages, but an early diagnosis can be crucial to limiting its progress and severity. Some studies indicate that rheumatoid arthritis causes the most joint damage in the first two years.

There is no single test to determine if you have RA. The symptoms often are similar to those of other types of arthritis and joint conditions. The types of symptoms you experience—and the severity—may differ markedly from those of another person with RA. To make matters more confusing, symptoms can vary in the same person: Symptoms develop over time, and only a few may be present in the early stages of RA.

Often, RA is diagnosed by recognizing the type and pattern of joint involvement; it is a hallmark of RA, for example, if the same areas are affected symmetrically on both sides of the body.

The typical symptoms of RA include:

• tender, warm and swollen joints

• symmetrical pattern

• joint inflammation often affecting the wrists, fingers, knees, feet, and ankles

• fatigue

• occasional fever

• a general sense of malaise

• pain and stiffness lasting for more than 30 minutes in the morning or after a long rest

• rheumatoid nodules (bumps under the skin—often formed close to the joints—that affect about a quarter of those with RA)

Less common symptoms can include neck pain and dry eyes and mouth. Very rarely, RA may cause inflammation of the blood vessels, the lining of the lungs or the sac enclosing the heart.

If you have any of these symptoms, you should visit a health care professional. He or she will take several elements into consideration before rendering a diagnosis:

• Medical history. Your description of the symptoms—including their duration and intensity—can help with the diagnosis.

• Physical examination. Your health care professional will do a physical exam and pay particular attention to your joints, skin, reflexes and muscle strength.

• Laboratory tests. Some lab tests can help establish the presence of RA. Your health care professional will probably order a test to detect rheumatoid factor (an antibody eventually present in the blood of most rheumatoid arthritis patients). It's inconclusive, however, since not all people with RA test positive for rheumatoid factor, especially in the early stages. Many normal individuals also have a positive rheumatoid factor test, so you could test positive and never develop the disease. A test called anti-cyclic citrullinated peptide, or anti-CCP, is now available and might be somewhat more specific than rheumatoid factors. Specificity is much higher when both tests are positive. Other common tests include one that indicates the presence of inflammation in the body (the erythrocyte sedimentation rate and the C-reactive protein), a serum albumin test (serum albumin concentrations are often decreased in people with RA), a white blood cell count and a blood test for anemia.

• X-rays. These can help determine the extent of joint destruction. If you identify RA in its early stages, x-rays may not be helpful in diagnosis. However, they can be used to monitor the disease's progress.