Table of ContentsView AllTable of ContentsPhysical ExamLab TestsImagingClassificationProgressionRemissionOther DiagnosesNext in Rheumatoid Arthritis GuideRheumatoid Arthritis Treatment: A Guide to Symptom Management

Table of ContentsView All

View All

Table of Contents

Physical Exam

Lab Tests

Imaging

Classification

Progression

Remission

Other Diagnoses

Next in Rheumatoid Arthritis Guide

Rheumatoid arthritisis an autoimmune disease. That means the immune system mistakenly attacks healthy tissues lining the joint, causing inflammation and pain. Getting an early and accurate RA diagnosis allows you to start the treatment you need to protect your joints and put the disease into remission.

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rheumatoid arthritis diagnosis

The journey toward getting a rheumatoid arthritis diagnosis begins with a comprehensive physical exam, assessing your overall health, and paying special attention to your joints. Your healthcare provider will identifyRA symptoms, such as swelling, stiffness, pain, limited movement, and joint deformities. They will also determine if your symptoms could be from other causes of joint pain likeosteoarthritis.

Your provider will look for small, firm bumps (nodules) that often develop under the skin in people with RA. They also check for signs that RA has spread beyond the joint, often involving your skin, heart, and lungs.

In addition to evaluating your physical symptoms, your healthcare provider will review your family history. Rheumatoid arthritis often runs in families, tripling your risk if an immediate family member (parent, sibling, or child) has the condition.However, many people with a family history don’t develop RA, and having a family history doesn’t mean you’re destined to have it.

Lab tests are used to classify your serostatus and measure the level of inflammation in your body:

Serostatus

Serostatus (loosely translated as “blood status”) refers to the key identifiers (biomarkers) of the disease in your blood. Your healthcare provider will run blood tests, looking for the primary biomarkers of RA: rheumatoid factor (RF) and anti-cyclic citrullinated peptide.

Because neither test is 100% indicative of RA, they’re used as part of the diagnostic process rather than as sole indicators.

When running blood tests for RA serostatus, lab technicians often use two techniques:

Serostatus Lab Test ResultsThe normal range for the RF test is 20 IU/ml or less. Test results above 20 IU/ml are considered positive for rheumatoid factor.However, about 20% of people with RA test negative for RF and about 5% of people who test positive for RF do not have RA.Anti-CCP test results less than 20 units (20 EU/ml) indicate you don’t have RA.Those above 20 units suggest RA. The higher the number, the more likely you are to have the condition. A negative anti-CCP test doesn’t rule out RA, as about 20% of RA patients are seronegative for anti-CCP.

Serostatus Lab Test Results

The normal range for the RF test is 20 IU/ml or less. Test results above 20 IU/ml are considered positive for rheumatoid factor.However, about 20% of people with RA test negative for RF and about 5% of people who test positive for RF do not have RA.Anti-CCP test results less than 20 units (20 EU/ml) indicate you don’t have RA.Those above 20 units suggest RA. The higher the number, the more likely you are to have the condition. A negative anti-CCP test doesn’t rule out RA, as about 20% of RA patients are seronegative for anti-CCP.

The normal range for the RF test is 20 IU/ml or less. Test results above 20 IU/ml are considered positive for rheumatoid factor.However, about 20% of people with RA test negative for RF and about 5% of people who test positive for RF do not have RA.

Anti-CCP test results less than 20 units (20 EU/ml) indicate you don’t have RA.Those above 20 units suggest RA. The higher the number, the more likely you are to have the condition. A negative anti-CCP test doesn’t rule out RA, as about 20% of RA patients are seronegative for anti-CCP.

Inflammatory Markers

Inflammationis a defining characteristic of rheumatoid arthritis, and certain markers in your blood reveal information about inflammation to your healthcare provider. Tests that look at key markers not only help confirm the initial RA diagnosis but are used periodically to see how well you’re responding totreatment.

Two common tests of inflammatory markers include the following:

ESR and CRP can also be used to diagnosearthritis remission, a state of low disease activity in which inflammation is more or less in check.

Your healthcare provider may order other tests to gauge your disease progression, as well.

Imaging Tests

The role of imaging tests in rheumatoid arthritis is to identify the signs of joint damage, including bone and cartilage erosion and the narrowing of the joint spaces.They can also help track the progression of the disease and establish whensurgeryis needed.

Each test can provide different and specific insights:

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Classification Criteria

The2010 ACR/EULAR Classification Criterialooks at four different clinical measures and rates each one on a scale of 0 to 5. A cumulative score of 6 to 10 can provide a high degree of confidence that you do, in fact, have rheumatoid arthritis.

While healthcare providers are the only ones who use these criteria, looking at them can help you understand why an RA diagnosis often can’t be made quickly or easily.

The strongest indicator of progressive joint damage in rheumatoid arthritis is considered to be seropositivity. That said, seronegativity doesn’t preclude progressive joint damage. Additionally, people who test positive for both rheumatoid factor and anti-CCP are more likely to have a rapid progression of joint damage than people who are positive for one or the other.

Factors that point to a poor prognosis with progressive joint damage include:

Diagnosing disease remission is just as or more challenging than your initial RA diagnosis. It requires not only the full exam and testing but also a subjective assessment of your symptoms and how you feel.

Accurately diagnosing remission is important because it determines whether certain treatments can be stopped or if going off of them is likely to cause arelapse.

To this end, the ACR has established what is called the DAS28. DAS is an acronym for “disease activity score,” while 28 refers to the number of joints that are examined in the assessment.

The DAS involves four scores:

These results are put through a complex mathematical formula to calculate your overall score.

Conditions With Similar Symptoms

Conditions with similar symptoms include other autoimmune disorders as well as connective tissue, neurological, and chronic inflammatory diseases such as:

Summary

Diagnosing rheumatoid arthritis involves several steps to identify signs of the disease and rule out other conditions that cause similar symptoms. Your healthcare provider will do a comprehensive physical exam, paying particular attention to your joints and looking for inflammation and swelling in the same joints on both sides of your body.

Your provider will also run lab tests that pick up RA biomarkers and signs of inflammation. They may also do various tests to rule out other health conditions. Diagnostic imaging is the final step. Your healthcare provider may take X-rays. However, MRI and ultrasound images uniquely help diagnose RA. They can show the earliest signs of RA and the severity of joint damage.

11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Das S, Padhan P.An Overview of the Extraarticular Involvement in Rheumatoid Arthritis and its Management.J Pharmacol Pharmacother. 2017 Jul-Sep;8(3):81-86. doi:10.4103/jpp.JPP_194_16.National Rheumatoid Arthritis Society.The genetics of rheumatoid arthritis.Birtane M, Yavuz S, Taştekin N.Laboratory evaluation in rheumatic diseases.World J Methodol. 2017;7(1):1-8. doi:10.5662/wjm.v7.i1.1ScienceDirect.Latex agglutination test.UCSF Health.Quantitative nephelometry test.Hospital for Special Surgery.Understanding rheumatoid arthritis lab tests results.MedlinePlus.Erythrocyte sedimentation rate (ESR).Arthritis Foundation.Rheumatoid arthritis diagnosis.Aletaha D, Neogi T, Silman AJ, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum. 2010;62(9):2569-81. doi:10.1002/art.27584American College of Rheumatology.Disease activity score (DAS)/Disease activity score in 28 joints (DAS28).Wasserman AM.Diagnosis and management of rheumatoid arthritis.Am Fam Physician. 2011;84(11):1245-52.Additional ReadingAletaha D, Neogi T, Silman A, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum.2010:62(9):2565-81 doi:10.1002/art.27584Anderson J, Caplan L, Yazdany J, et al.Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice.Arthritis Care Res.2012; 64(5):6. doi:10.1002/acr.21649Bykerk V, Masarotti E.The new ACR/EULAR remission criteria: rationale for developing new criteria for remission.Rheumatology. 2012;51:vi16vi20. doi:10.1093/rheumatology/kes281Smolen J, Aletaha D, McInnes I.Rheumatoid arthritis.Lancet.2017;388(10055):2023-38. doi:10.1016/So140-6736(16)30173-8

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Das S, Padhan P.An Overview of the Extraarticular Involvement in Rheumatoid Arthritis and its Management.J Pharmacol Pharmacother. 2017 Jul-Sep;8(3):81-86. doi:10.4103/jpp.JPP_194_16.National Rheumatoid Arthritis Society.The genetics of rheumatoid arthritis.Birtane M, Yavuz S, Taştekin N.Laboratory evaluation in rheumatic diseases.World J Methodol. 2017;7(1):1-8. doi:10.5662/wjm.v7.i1.1ScienceDirect.Latex agglutination test.UCSF Health.Quantitative nephelometry test.Hospital for Special Surgery.Understanding rheumatoid arthritis lab tests results.MedlinePlus.Erythrocyte sedimentation rate (ESR).Arthritis Foundation.Rheumatoid arthritis diagnosis.Aletaha D, Neogi T, Silman AJ, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum. 2010;62(9):2569-81. doi:10.1002/art.27584American College of Rheumatology.Disease activity score (DAS)/Disease activity score in 28 joints (DAS28).Wasserman AM.Diagnosis and management of rheumatoid arthritis.Am Fam Physician. 2011;84(11):1245-52.Additional ReadingAletaha D, Neogi T, Silman A, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum.2010:62(9):2565-81 doi:10.1002/art.27584Anderson J, Caplan L, Yazdany J, et al.Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice.Arthritis Care Res.2012; 64(5):6. doi:10.1002/acr.21649Bykerk V, Masarotti E.The new ACR/EULAR remission criteria: rationale for developing new criteria for remission.Rheumatology. 2012;51:vi16vi20. doi:10.1093/rheumatology/kes281Smolen J, Aletaha D, McInnes I.Rheumatoid arthritis.Lancet.2017;388(10055):2023-38. doi:10.1016/So140-6736(16)30173-8

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Das S, Padhan P.An Overview of the Extraarticular Involvement in Rheumatoid Arthritis and its Management.J Pharmacol Pharmacother. 2017 Jul-Sep;8(3):81-86. doi:10.4103/jpp.JPP_194_16.National Rheumatoid Arthritis Society.The genetics of rheumatoid arthritis.Birtane M, Yavuz S, Taştekin N.Laboratory evaluation in rheumatic diseases.World J Methodol. 2017;7(1):1-8. doi:10.5662/wjm.v7.i1.1ScienceDirect.Latex agglutination test.UCSF Health.Quantitative nephelometry test.Hospital for Special Surgery.Understanding rheumatoid arthritis lab tests results.MedlinePlus.Erythrocyte sedimentation rate (ESR).Arthritis Foundation.Rheumatoid arthritis diagnosis.Aletaha D, Neogi T, Silman AJ, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum. 2010;62(9):2569-81. doi:10.1002/art.27584American College of Rheumatology.Disease activity score (DAS)/Disease activity score in 28 joints (DAS28).Wasserman AM.Diagnosis and management of rheumatoid arthritis.Am Fam Physician. 2011;84(11):1245-52.

Das S, Padhan P.An Overview of the Extraarticular Involvement in Rheumatoid Arthritis and its Management.J Pharmacol Pharmacother. 2017 Jul-Sep;8(3):81-86. doi:10.4103/jpp.JPP_194_16.

National Rheumatoid Arthritis Society.The genetics of rheumatoid arthritis.

Birtane M, Yavuz S, Taştekin N.Laboratory evaluation in rheumatic diseases.World J Methodol. 2017;7(1):1-8. doi:10.5662/wjm.v7.i1.1

ScienceDirect.Latex agglutination test.

UCSF Health.Quantitative nephelometry test.

Hospital for Special Surgery.Understanding rheumatoid arthritis lab tests results.

MedlinePlus.Erythrocyte sedimentation rate (ESR).

Arthritis Foundation.Rheumatoid arthritis diagnosis.

Aletaha D, Neogi T, Silman AJ, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum. 2010;62(9):2569-81. doi:10.1002/art.27584

American College of Rheumatology.Disease activity score (DAS)/Disease activity score in 28 joints (DAS28).

Wasserman AM.Diagnosis and management of rheumatoid arthritis.Am Fam Physician. 2011;84(11):1245-52.

Aletaha D, Neogi T, Silman A, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum.2010:62(9):2565-81 doi:10.1002/art.27584Anderson J, Caplan L, Yazdany J, et al.Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice.Arthritis Care Res.2012; 64(5):6. doi:10.1002/acr.21649Bykerk V, Masarotti E.The new ACR/EULAR remission criteria: rationale for developing new criteria for remission.Rheumatology. 2012;51:vi16vi20. doi:10.1093/rheumatology/kes281Smolen J, Aletaha D, McInnes I.Rheumatoid arthritis.Lancet.2017;388(10055):2023-38. doi:10.1016/So140-6736(16)30173-8

Aletaha D, Neogi T, Silman A, et al.2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Arthritis Rheum.2010:62(9):2565-81 doi:10.1002/art.27584

Anderson J, Caplan L, Yazdany J, et al.Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice.Arthritis Care Res.2012; 64(5):6. doi:10.1002/acr.21649

Bykerk V, Masarotti E.The new ACR/EULAR remission criteria: rationale for developing new criteria for remission.Rheumatology. 2012;51:vi16vi20. doi:10.1093/rheumatology/kes281

Smolen J, Aletaha D, McInnes I.Rheumatoid arthritis.Lancet.2017;388(10055):2023-38. doi:10.1016/So140-6736(16)30173-8

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