Diagnosing Rheumatoid Arthritis

Diagnosing rheumatoid arthritis (RA), in the early stages, can be difficult. There is no single test that can clearly identify rheumatoid arthritis. Instead, doctors diagnose rheumatoid arthritis based on factors that are strongly associated with this disease. The American College of Rheumatology uses this list of criteria:

1. Morning stiffness in an around the joints for at least one hour.
2. Swelling or fluid around three or more joint areas simultaneously.
3. At least one swollen area in the wrist, hand, or finger joints.
4. Swelling or fluid of the same joint on both sides of body (symmetric arthritis).
5. Rheumatoid nodules, firm lumps in the skin of people with rheumatoid arthritis, usually in pressure points of the body, most commonly the elbows.
6. Abnormal amounts of serum rheumatoid factor in the blood.
7. X-ray changes in the hands and wrists typical of rheumatoid arthritis, with wearing away of bone around the involved joints.

rheumatoid arthritis is officially diagnosed if four or more of these seven factors are present. The first four must have been present for six weeks.

These criteria are helpful, but diagnosing rheumatoid arthritis is still difficult.

Symptoms can come and go. To diagnose RA your doctor may need to see your joints when the disease is active for several reasons:

• Patients may find it hard to describe symptoms to doctors in a way that allows them to make the diagnosis.
• rheumatoid arthritis can appear similar to other common causes of joint pain, leading to the wrong diagnosis.
• Patients often think they are feeling "normal" aches and pains and ignore or just live with their symptoms for a long time before seeking treatment.

Several diseases can masquerade as rheumatoid arthritis, which contributes to the difficulty in diagnosis. They include:

• Osteoarthritis, or "regular" arthritis
• Gout
• Fibromyalgia
• Other autoimmune diseases such as systemic lupus erythematosus (lupus)
• Joint inflammation caused by infections

Because of these difficulties, a proper diagnosis is often missed early on. In fact, the average time between the onset of symptoms and the official diagnosis of rheumatoid arthritis is almost nine months!

Though diagnosing rheumatoid arthritis isn't easy, it is extremely important. Delaying the diagnosis can be harmful because joint damage can occur early in the disease. Some experts think that limiting this early joint damage can have huge long-term benefits.

The problem arises when it looks like someone has rheumatoid arthritis but they don't yet meet the criteria for diagnosis. If someone doesn't actually have it, it would be wrong to treat them because the medicines are powerful and can have serious side effects.

If you or your doctor suspects rheumatoid arthritis, your doctor will follow a road map to either diagnose or rule out the disease. It will take time, but eventually you will have a definite answer. There is some information and a few tools that are valuable to doctors in diagnosing rheumatoid arthritis.

• A careful history. Take note of the frequency, severity, and time of day of your symptoms. Pass this information on to your doctor.
• A physical examination. Your doctor will look closely at your joints to detect signs of inflammation or damage.
• Laboratory tests. These can include tests for inflammation in your blood or joint fluid.
• X-rays. While not always helpful right away, they can be useful at identifying any joint damage that has already occurred.

In early rheumatoid arthritis, there are no instant answers, either for you or your doctors. The best strategy is close follow-up by a physician. If you think you have rheumatoid arthritis, see a rheumatologist or consult with your primary care doctor, and visit regularly.