Rheumatoid Arthritis: Diagnosis

It is now widely accepted that a “therapeutic window of opportunity” exists for people with RA and that the disease is much more amenable to treatment within this window. Thus, a person with suspected RA should be rapidly evaluated, including a detailed history, physical exam, blood work, and joint X-ray to confirm the diagnosis so that appropriate treatment can be started within weeks to prevent further damage. It is often difficult to diagnose rheumatoid arthritis (RA). A specialist in RA (known as a rheumatologist) is usually required to establish the diagnosis.

The diagnosis of RA is made based on the careful analysis of many factors. A thorough history and physical examination are essential. The typical symptoms of RA are that of a chronic (longer than six weeks), fixed, symmetric inflammatory polyarthritis affecting most commonly the small joints of the wrists, hands and feet. It is recommended that general practitioners do not delay the referral to rheumatologists when they see one or more of the following symptoms: positive hand and feet squeeze test of the hands and feet, three or more swollen joints, or morning stiffness that lasts 30 minutes or more.

Certain laboratory studies can be helpful when considering the diagnosis. It is important to note that a diagnosis cannot be made based on any specific blood test, though some blood tests are helpful for ruling out other diseases that may have similar symptoms. X-rays are often helpful when considering the diagnosis of RA, particularly to look for any signs of joint destruction.