9 Steps to Diagnosing Rheumatoid Arthritis

by Sarah Ellis Health Writer

If you’re dealing with chronically inflamed, aching joints, you’re not alone. Rheumatoid arthritis affects 1.3 million Americans—but it’s surprisingly multifaceted and not always simple to diagnose. If joint pain and stiffness make you wonder whether you might have this disease, it’s smart to talk with your doc. The sooner you get a handle on RA symptoms through proper treatment, the easier it is to prevent long-term join damage. Follow along, as we walk through the diagnosis process.

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Pay Attention to Your Symptoms

People of all ages can develop symptoms of RA. “Patients early on may have swelling of the finger joints, wrist joints, or knees,” explains Jonathan Samuels, M.D., a rheumatologist at NYU Langone Health in New York City. “They may also have stiffness in the mornings, or difficulty using and opening jars, doorknobs, making a fist, or shaking hands.” Your symptoms may be mild at first, then progress to more serious inflammation and pain over a period of weeks or months.

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Symptoms Are Often Symmetrical

Something else to know about RA aches and pains—they can affect both sides of your body at once. “When it’s a symmetrical process, it alerts you that there’s something going on,” says Dr. Samuels. But while symmetrical symptoms make it more likely that you have RA, don’t ignore joint pain if it’s affecting just one side of the body. “Patients may think that they injured their joint or something like that,” Dr. Samuels notes, when it’s really a sign of RA.

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Call Your Doctor

If your joint pain is getting worse (or just not getting better), head to your primary care doctor, who will rule out the possibility of another condition. “Rheumatoid arthritis is not the only thing that causes joint pain and stiffness,” explains Steven Vlad, M.D., PhD., a rheumatologist at Tufts Medical Center in Boston, MA. “People can have similar symptoms from a virus for a few days, and then it’ll go away on its own.” But if the swelling is happening over a period of weeks—especially if RA runs in your family—this is a major clue that you could have the condition.

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See a Rheumatologist

Once your physician rules out other options and determines that you probably have RA, you’ll likely be sent to see a specialist who can make the official diagnosis. “We see the patient and figure out if what is going on is consistent with rheumatoid arthritis,” Dr. Vlad explains. This process may take a few weeks or several months, depending on how noticeable your symptoms are. Your specialist will also talk with you about your medical history and may run a few diagnostic tests. (More on that next.)

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Get Tested for Antibodies

There are several blood tests used to diagnose rheumatoid arthritis. The first one your doctor may give you looks for proteins produced by your immune system called rheumatoid factors, says Dr. Vlad. These antibodies are found in the blood of 80% of people with RA. The second test looks for something called anti-cyclic citrullinated peptides (anti-CCP), antibodies which mistakenly attack your own cells and are found in 60% to 70% of people with RA. Though neither test is conclusive, if you have either or both antibodies, your chances are higher that you may have RA.

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Have Your Inflammation Levels Checked

In addition to the presence of antibodies that are hallmarks of an autoimmune condition like RA, your doctor may administer two other tests that look for markers of inflammation in the body—another indicator for the disease. The first test measures erythrocyte sedimentation rate (ERS) while the other takes stock of your C-reactive protein (CRP) levels in the blood. Together with information from your antibody test, these are useful tools to determine if you have RA.

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Know Your Medical History

Your rheumatologist will likely ask you questions about your family and their medical history. RA is an autoimmune disease associated with certain genetic markers, so if a relative has it, that makes it more likely that you have it as well. Your doctor will ask about your symptoms: when they developed, which joints are hurting, whether the swelling is symmetric, if symptoms are consistent or on-and-off, and whether you’ve experienced anything like this in the past.

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Learn Your Diagnosis

No one likes to be told they have an illness, and the frustrating thing with RA is that there is currently no cure, says Dr. Vlad. The good news: There are multiple treatment options available that have proven to be hugely successful at keeping symptoms of rheumatoid arthritis in check. Another reason to act fast: “If people go untreated, there’s going to be a substantial number who develop long-term disability because of joint problems,” he says.

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Start Treatment

Medications are the most common method for treating RA. “We have so many options now,” Dr. Samuels says. “Different medications provide different ways of attacking the exact processes causing RA.” Patients typically start with a disease-modifying anti-rheumatic drug (DMARD). Dr. Vlad explains that these drugs work “to prevent damage, to reduce swelling, and help with other symptoms.” You and your provider can go from there to determine whether you need additional medication.

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Be Proactive With Your Care

Now that you’re on a treatment plan, your symptoms should drastically improve. But you should still stay in touch with your doctor to report back on how you’re doing, says Dr. Samuels. And be sure you consult with your rheumatologist if you continue to have pain or discomfort. Inflammation flares can happen, but they shouldn’t be so bad that you aren’t able to go about your day. RA may be with you for life, but it doesn’t have to rule your life—it’s totally possible to thrive with this condition.

Sarah Ellis
Meet Our Writer
Sarah Ellis

Sarah Ellis is a wellness and culture writer who covers everything from contraceptive access to chronic health conditions to fitness trends. She is originally from Nashville, Tennessee and currently resides in NYC. She has written for Elite Daily, Greatist, mindbodygreen and others. When she’s not writing, Sarah loves distance running, vegan food, and getting the most out of her library card.