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- Rheumatoid arthritis does not look the same in all people.
It's more common in women.
It can begin at any age,
but it's most often seen
in people in their forties and fifties.
The diagnosis of rheumatoid arthritis
is usually made by a rheumatologist.
Your history of pain and swelling,
a physical exam, blood work,
and maybe x-rays, as well,
they help determine the diagnosis.
Often RA is diagnosed by eliminating
or ruling out any other possible cause of your symptoms.
The first thing that happens is usually a history
and physical exam.
Your rheumatologist will examine your joints
for swelling and pain,
and then they count the number of joints that involved.
The exam consists of feeling all the joints of your hands,
wrists, elbows,
and this is called a joint count.
Sometimes joints are painful,
and they don't have noticeable swelling,
and sometimes joints are swollen, but there's no pain.
Your rheumatologist will do this examination
at all of your future appointments,
and this is how they can tell
how well you are responding to the treatment that you're on.
The length of time that you've been experiencing
this joint pain and swelling is also important.
So in rheumatoid arthritis,
this pain and swelling has typically been around
for about six weeks.
Your rheumatologist will also
get a detailed history of your health,
and so that has helped to help them understand
if you have other medical conditions
that might be associated with RA,
or might not, it's okay,
and if there are conditions that might impact
the kind of medications that you're going to be prescribed.
You might have to fill out other questions
or surveys about your health,
and so some of those might include:
When did the symptoms first begin?
Does anyone in your family have RA
or even another autoimmune disease?
How have these symptoms affected your ability to work?
How have they affected your ability
to do your daily activities?
How have they affected your ability
to participate in leisure activities?
So next there are several blood tests
that are used to help diagnose RA.
So the very first one is called a rheumatoid factor,
and the rheumatoid factor, it's useful to help diagnosis,
and about 75% of cases have a positive rheumatoid factor
over the course of the illness,
but a rheumatoid factor positivity
may be seen in other chronic inflammatory diseases as well,
so that's not the end all.
The next blood test is called
the anti-cyclic citrullinated peptide antibody,
anti-CCP, much easier to say,
is more specific than a rheumatoid factor.
It means it does not occur in other conditions besides RA.
If you have high levels of these antibodies,
the anti-CCP antibodies,
that could mean that you have a more aggressive form of RA.
Not all people will have a positive rheumatoid factor
or a positive anti CCP, or both,
and that's called seronegative RA,
which means you have RA by the symptoms only,
but not by the blood work.
The next thing we measure is called
the erythrocyte sedimentation rate, or ESR,
and that's used to measure inflammation in the blood,
and a lot of times we're going to see
that that's elevated in RA,
and this is going to be checked on a regular basis,
and again, it helps monitor how well
your disease is under control,
so you will get that test a lot in your future.
The C-reactive protein blood test
is another marker of inflammation,
and like the ESR,
it's often elevated when your RA is active.
And so, again, this is another blood test
that you will get often
to see how well your RA is controlled.
So RA is progressive,
and that means it gets worse with time
if you don't have treatment.
We have data that damage happens quickly,
especially in the first two years of having RA.
We know that if we can begin the treatment for RA early,
we can slow that damage.
Your rheumatologist might order x-rays or ultrasound,
or even MRI of your hands, wrists, and other joints
to see if any damage has already happened
because we know the swelling, chronic swelling,
may have caused cartilage and bone to erode.
X-rays may be done every couple years afterwards,
again, to make sure your disease is well controlled.
Ultrasound is another imaging technique
that can be useful in monitoring disease.
An ultrasound can see even small amounts of information
that can't be felt,
and it can see damage in the joints, as well as swelling
around the tendons and other soft tissues.
So you can see how RA may look different in each person
because some people may have all of the symptoms.
Some people may have only have some of the symptoms,
but it's important to work with your rheumatologist
to make sure this is your diagnosis.
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