Diagnosis Of Rheumatoid Arthritis
How Rheumatism Is Diagnosed



Rheumatoid Arthritis Diagnosis


How Is It Diagnosed?
The Rheumatoid Arthritis Test
Tests and Assessments
Ruling Out Other Causes

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Rheumatoid Arthritis Guide
Bone and Joints Problems
How Is It Diagnosed?

The sooner rheumatoid arthritis can be diagnosed the better. Why? Because early intervention (lifestyle adjustments, medications or even enrollment in clinical trials for new drugs) may halt or slow down the progression of the disease. Yet, an early diagnosis can be challenging because early symptoms of rheumatoid arthritis (RA) are similar to so many other conditions. As there is no single test or gold standard for diagnosing RA, the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) recommend the following classification criteria:

The Rheumatoid Arthritis Test

This test is called the 2010 ACR-EULAR Classification Criteria. Doctors assess the presence of each set of criteria from A to D, and score accordingly.

Criteria Score
A. Joint Involvement
1 large joint is affected. Large joint refers to the elbows, hips, shoulders, knees and ankles. 0
Between 2 and 10 large joints affected. 1
Between 1 and 3 small joints (with or without involvement of large joints). Small joints refer to the fingers, thumb, toes and wrist.
Between 4 and 10 small joints (with or without involvement of large joints). 3
More than 10 joints (including at least 1 small joint) is affected. 5
B. Blood Test Results (Serology)
At least 1 test result is necessary for classification.
Rheumatoid factor (RF) blood test: Negative.
Anti-citrullinated protein antibody (ACPA) blood test: Negative.
RF: Low-positive
ACPA: Low-positive
RF: High-positive
ACPA: High-positive
C. Other Blood Test Results
Acute-phase reactants (at least 1 test result is needed for classification)
Erythrocyte sedimentation rate (ESR, or sed rate) blood test: Normal
C-reactive protein (CRP) blood test: Normal
ESR: Abnormal
CRP: Abnormal
D. Duration of Symptoms
How long the patient reports symptoms of rheumatoid arthritis (pain, tenderness and swelling of any joint). Only joints which are symptomatic at time of assessment should be taken into account. In other words, if joints in the hands for example were previously painful, but no longer so, they should not be taken into account for the purpose of this test.
Less than 6 weeks 0
6 weeks or more. 1
Add Up Your Total Score Score: ?


Rheumatoid arthritis is diagnosed if a patient has a combined score of 6 or more.

Tests And Assessment

Physical Examination

Your doctor will carry out a physical examination, assessing your joints to see how easily they move and for signs of swelling. He will also ask about your symptoms and how long you have been experiencing them. It is important to tell your doctor about all symptoms, even if you think they are not relevant. This will help him make a correct diagnosis. Once the physical examination is completed (and RA is still suspected) other tests may be ordered. These are outlined below.

Blood Tests

No blood test can definitively diagnose RA, but combined with other criteria outlined above, they can contribute to an overall diagnosis.

Rheumatoid factor: This checks for the presence of an antibody called rheumatoid factor in the blood. It is present in 80 percent of people with RA. However, it can also be present in 5 to 10 percent of healthy women. And it is also frequently absent in elderly-onset RA (considered where the disease first appears after the age of 60). It is usually combined with either an ESR or CRP blood test.
Anti-citrullinated protein antibody (ACPA): Newer test, considered even more accurate than RF but not yet as readily available.
Erythrocyte sedimentation rate (ESR): Tests for inflammatory conditions. A sample of red blood cells from your blood is placed into a test tube of liquid. The cells are timed as they fall to the bottom of the test tube. The faster they fall, the more likely the presence of an inflammatory condition like RA.
C-reactive protein (CRP): CRP is a protein produced by the liver. Higher levels indicate the presence of inflammation in your body. Read, C-reactive protein test for more details.

Imaging Techniques

X-Rays: X-rays are not generally helpful in detecting the presence of early RA because they cannot show images of soft tissue.
Dexa Scan: Typically used to diagnose osteoporosis, this scan may be useful in detecting early bone loss due to RA (2 to 27 months after onset).
Ultrasound: Power Doppler ultrasonography (PDUS) or quantitative ultrasound (QUS) are two types of special ultrasound scans which may be helpful in diagnosing RA. PDUS can help monitor inflammation of the joints and QUS can detect bone loss in the fingers.
Magnetic Resonance Imaging (MRI): An MRI scan can help detect bone loss in the hands where X-rays cannot.
Thermography Screening: Also called thermal imaging, this is the use of a special infrared camera to produce thermograms (images) to map patterns of blood flow and heat on or near the skin's surface. May help differentiate between osteoarthritis and RA.

Ruling Out Other Causes

Early symptoms of RA can mimic those of other problems. The above tests will help to rule out:

Osteoarthritis: Often confused with RA, but osteoarthritis tends to affect fewer joints and the joints are less inflamed.
Infectious arthritis: Including septic arthritis, Lyme disease, viral arthritis, bacterial endocarditis, fungal and mycobacterial arthritis.
Post infectious or reactive arthritis: Including rheumatic fever, inflammatory bowel disease (IBD) and Reiter syndrome. Note: there are hundreds of different types of arthritis.
Gout: Crystal induced arthritis.
Other rheumatic diseases: Such as scleroderma, systemic lupus, Behcet's disease and Still's disease (also known as juvenile RA).
Other diseases: Cancers, hepatitis C, fibromyalgia, chronic fatigue syndrome, Kawasaki's disease, psoriatic arthritis, Whipple's disease and AIDS.

  Related Articles on Rheumatism

For more advice, see the following:

Treatment of rheumatoid arthritis: Medications and surgery.
Biologic drugs: Advanced treatment in RA.
Risk factors for rheumatoid arthritis: Irregular periods, smoking etc.
Rheumatoid arthritis medications: Pills, injections and more.

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