Accurately Diagnosing Rheumatoid Arthritis

John A. Flynn, M.D., M.B.A. | Nov 9, 2017

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Early diagnosis and immediate, aggressive treatment of rheumatoid arthritis are crucial because only a brief window of opportunity exists to prevent permanent disability and lifelong complications. However, early diagnosis is often difficult because the initial symptoms may mimic those of osteoarthritis, influenza (flu) and other viral illnesses. Further, the joints may not be red or swollen and may appear normal on X-rays.

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Find the right doctor

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To increase your chances of getting an accurate and early diagnosis, choosing the right doctor is important. Because rheumatoid arthritis is not common, your general physician may have little experience with the disease. When in doubt, ask for a referral to a board-certified rheumatologist—a physician who specializes in arthritis and other rheumatic diseases. Rheumatologists have extensive training and experience in diagnosing and treating these diseases.

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Seven diagnostic criteria: part 1

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Rheumatologists follow standardized guidelines for evaluating anyone who might have rheumatoid arthritis. No single laboratory test or diagnostic procedure can confirm the diagnosis. Instead, seven diagnostic criteria are used:

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Seven diagnostic criteria: part 2

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  • Morning stiffness
  • Arthritis in three or more joints
  • Arthritis in the hand joints
  • Symmetrical arthritis
  • Rheumatoid nodules
  • Elevated blood level of rheumatoid factor
  • Radiographic (X-ray) changes
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Next steps

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The diagnosis will be rheumatoid arthritis if the first four criteria have been present for at least six weeks, long enough to rule out the possibility that a virus has caused the arthritis symptoms. Even if you don’t meet the four-of-seven criteria standard, you still may have rheumatoid arthritis. If you have two or three of the criteria, more testing is necessary because if you do have rheumatoid arthritis, even a short delay in beginning treatment can be harmful.