Diagnosing rheumatoid arthritis
There is no single test to diagnose rheumatoid arthritis, and other conditions with similar symptoms may need to be ruled out first.
Doctors diagnose rheumatoid arthritis based on symptoms and factors including:
- Joint pain and swelling that is usually symmetrical and normally first involves the small joints in the hands. The lining of the affected joint becomes inflamed, leaving the skin over the joint warm, red and swollen.
- Joint stiffness that is worse in the morning - again, this often improves once you start moving around.
- Loss of appetite.
- Generally feeling unwell, lethargy, and a mildly raised temperature
- Skin nodules. These are firm lumps in the skin of people with rheumatoid arthritis. The nodules usually develop in pressure points of the body, most commonly the elbows.
- Anaemia - this is a condition where the blood is unable to carry enough oxygen, due to a low number of red blood cells. It often leaves you feeling tired and lethargic.
Your doctor will ask you about your symptoms and it’s important to tell him or her about all of your symptoms, not just the ones you think are important. Your doctor will also conduct a physical examination and will check your joints to see if they are swollen and to find out how easily they move. After discussing your symptoms and conducting a physical examination, your doctor may also refer you for some tests to help confirm the diagnosis. These may include blood tests, X-rays and MRI (magnetic resonance imaging) scans.
Symptoms of rheumatoid arthritis can come and go. To diagnose RA, your doctor may need to see your joints when the disease is active for several reasons:
- Patients may find it hard to describe symptoms to a doctor in a way that allows the doctor to make a diagnosis.
- Rheumatoid arthritis can have similar effects to other common causes of joint pain, leading to the wrong diagnosis.
- Patients often think they are feeling ’normal‘ aches and pains, and they ignore or just live with their symptoms for a long time before seeking treatment.
Several diseases can masquerade as rheumatoid arthritis, which contributes to the difficulty of diagnosis. These other diseases include:
- Osteoarthritis, or 'wear and tear‘ arthritis
- Other autoimmune diseases such as systemic lupus erythematosus (lupus/SLE)
- Joint inflammation caused by infections
Although diagnosing rheumatoid arthritis isn't easy, it is extremely important to identify correctly people with the disease. Delaying the diagnosis may be harmful because joint damage can occur early in the disease. Experts think that preventing early joint damage can have huge long-term benefits.