Signs You Might Have RA

M.A., Health Writer
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More than 54 million adults in the United States have been told they have some form of arthritis. If it's rheumatoid arthritis (RA), 1.5 million diagnosed with it have exhibited signs and symptoms that helped their rheumatologist identify this systemic autoimmune and inflammatory disease. Here to explain exactly what those are is Erika Noss, M.D., Ph.D., assistant professor and rheumatologist at the University of Washington School of Medicine.


Who gets RA?

Anyone can develop RA, but it's most common in people age 50 to 70, Dr. Noss says. It's also two-to-three times more common in women. People with certain human leukocyte antigen (HLA) class II genotypes are at higher risk, especially when environmental factors such as smoking, gum disease, or obesity are present. According to National Institutes of Health, HLA complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders such as viruses and bacteria.


About that joint pain

This major symptom usually first involves the small joints of the hands and feet, Dr. Noss says. The joint lining, or synovium, swells, causing discomfort including pain and stiffness. In the hand, the most commonly affected are the proximal interphalangeal (PIP), metacarpophalangeal (MCP), and wrist joints. In the feet, the metatarsophalangeal (MTP) joints are usually affected first, along with the subtalar joints. Nodules can occur under the skin's surface, most commonly at pressure points.


How RA differs

Symptoms occur on both sides of the body, she says. They may also be present in the knees, elbows, and sometimes, the shoulders, ankles, hips, and neck. "With RA, it's not just about one joint, as in osteoarthritis, when an injury could occur from overuse," says Dr. Noss. "Pain in multiple joints is characteristic of RA. Joints can also appear swollen and warm. Over time, if RA is not treated, joints may become deformed and lose function."


Stiffness gives a clue

Morning stiffness is an important symptom of RA, says Dr. Noss. "It's not just a little bit of stiffness that goes away after a few minutes. People with RA may take an hour or two to loosen up, a bit like the 'Tin Man' who needs oil in 'The Wizard of Oz.' I ask patients, 'How long does it take you to get moving in the morning?' A person with RA may say 'one to two hours.'"


How imaging helps

Doctors may suspect this disease from a person's medical history, but to diagnose RA, Dr. Noss says it's necessary to see swelling in the joints. "Swelling can be obvious on a physical exam when we feel the joint space. However, in early or mild RA, sometimes further diagnostic testing is needed, such as an ultrasound or MRI, to prove there is joint swelling. We frequently also order X-rays. Although X-rays generally don’t show joint swelling, they do if there has been any joint damage.”


How laboratory tests confirm diagnosis

“Testing for specific antibodies in the blood helps us diagnose RA," says Dr. Noss. These tests are the rheumatoid factor (RF) and anti-CCP (anti-cyclic citrullinated peptide) antibodies. The anti-CCP test is more specific for RA. Approximately 70 percent of people with RA will test positive for one or both tests. However, a positive test, by itself, does not mean a patient has RA. In addition, a patient may have RA without having a positive test.


Additional blood tests also help

Other blood tests support RA activity, Dr. Noss says. These detect "whole body" inflammation, including the C-reactive protein or CRP, and the erythrocyte sedimentation rate or ESR. "Remember, though, that not everyone with RA has elevations in these tests," she says. "We rely on a number of factors to diagnose RA, since one observation or test alone is not enough to determine its presence."


Catch it early for best results

Dr. Noss says she's watched new treatments change the face of RA. "Starting in the '80s, we've seen increasing numbers of effective treatments, especially those that both treat symptoms and help prevent or slow joint damage. Because of that, we always try to diagnose the disease as early as possible to be in the best position to help people in the long term. The goal with all RA patients is to help them achieve remission or at least low disease activity."


About more than joints

Other symptoms can occur with RA, says Dr. Noss. These include fatigue, weakness, anemia, shortness of breath, dry eyes and mouth, weight loss, and just the feeling that "I'm not well." It's important to discuss all your symptoms openly with your rheumatologist, since this helps your doctor decide if it's RA or "something else."


How to best treat RA

Right now the most common RA treatments include:

  • Disease modifying anti-rheumatic drugs (DMARDs) to slow disease progression
  • Biologic response modifiers to reduce inflammation and joint damage
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, also to reduce inflammation and discomfort

Stick with it: Your rheumatologist will work with you to determine the best course of treatment for you and your RA, says Dr. Noss.