Facts About a Rheumatoid Arthritis Diagnosis

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There are many things to learn when you have rheumatoid arthritis (RA). In order to get started on your journey with the condition, you first have to get a diagnosis. The process of getting an answer about the symptoms you’ve been having is not always straightforward. Let’s go through the process.

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RA has some hallmark signs

Among the common signs of RA are morning stiffness lasting longer than 30 minutes, three or more painful joints, subcutaneous nodules, and symmetrical involvements of joints, for instance, both wrists, both ankles, and so on. RA is an autoimmune disease, which means fatigue and low-grade fevers are also common. In addition, RA is a systemic condition that affects the whole body, so early signs can also include, eye inflammation or other systemic symptoms.

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The role of blood tests in RA diagnosis

Several blood tests can help diagnose RA by detecting inflammation and RA antibodies. They can also help indicate possible severity and complications of the disease. These tests include rheumatoid factor, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and anti-CCP antibody. Initial blood tests will also test for other factors to differentiate possible RA from other autoimmune diseases.

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But blood tests aren't definitive

Keep in mind that blood tests alone can’t definitively indicate that a person has RA. For instance, up to 30 percent of people who have RA will not test positive for rheumatoid factor. This is called having sero-negative RA. As well, the ESR and CRP measure general inflammation in the body and may not be reliable indicators of RA inflammation.

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Imaging tests can help with diagnosis

In addition to blood tests, you will likely be sent for imaging tests of the affected joints, such as X-rays. This can be especially useful if you have had RA for a while, but early in the condition, X-rays may not show that something is wrong. Early RA damage to joints is not detectable on an X-ray, but the progression of joint damage over time is visible. Your doctor may order an magnetic resonance imaging test (MRI) or an ultrasound, which can provide more information about changes in a person’s body.

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RA diagnosis isn’t just about tests

Most rheumatologists make their diagnosis based on your medical history and doing a physical exam, using blood and imaging tests as confirming data. You can help by writing point form notes on your general health history, as well as information about the symptoms that brought you to the rheumatologist. Tracking your symptoms in a notebook or by using a symptom tracker app can help you put together this information.

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Other disorders have similar symptoms

Several other conditions mimic the symptoms of RA. Some are other types of autoimmune arthritis, such as psoriatic arthritis, lupus, juvenile idiopathic arthritis, and others. Gout and osteoarthritis can sometimes be confused for RA, but they are very different conditions.

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Early diagnosis is critical

Getting a diagnosis as early as possible is key to halting damage to joints and other systems in your body. Advances in medication have led to a change in treatment approach. An early aggressive treatment plan can be critical to getting RA under control and even achieving remission. Preventing RA inflammation from damaging your body is an essential part of protecting your ability to live your life as fully as possible.

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RA can be difficult to diagnose

RA is a complex autoimmune disease that can prove challenging to identify. It can take quite a while from the time your first symptoms appear to when you get a diagnosis. One study found that the lag time between the appearance of the first symptoms to the time of diagnosis ranged from four weeks to almost 10 years. People who had a positive rheumatoid factor or progressive disease were more likely to get diagnosed sooner.

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Why does it take so long to get diagnosed?

RA is a complex disease, and symptoms may develop months before diagnostic tests show inflammation. RA symptoms also overlap with other conditions and can be difficult to identify, especially in the early stages of the condition. Additionally, family doctors may not be aware of all the signs and symptoms, thus creating a delay in referral to a rheumatologist.

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What to do if you can’t get diagnosed

You may need to see several doctors in order to get a diagnosis. Don’t hesitate to get a second opinion — or even a third or fourth — if you are having trouble getting a diagnosis. Talk to other people with RA in your area or online to find a good rheumatologist. Your family doctor can also be an ally in this search. Trust your own sense of what is going on in your body and keep pushing to get the answers you need.