Table of ContentsView AllTable of ContentsWhat Is RA?Blood TestsImaging TestsMonitoring Tests
Table of ContentsView All
View All
Table of Contents
What Is RA?
Blood Tests
Imaging Tests
Monitoring Tests
Rheumatoidarthritis(RA) tests used to diagnose and monitor the condition include a combination of lab tests and imaging studies. There is no single test that conclusively diagnoses RA, but rather several factors are used.
The blood tests can show ifyour body has inflammationand is making specific proteins (antibodies) that are common when you have RA.Rheumatoid factor (RF). anti-cyclic citrullinated peptide (Anti-CCP), and antinuclear antibody (ANA) are among the lab tests used. Imaging tests include X-rays, MRIs, ultrasounds, and CT scans.
This article discusses rheumatoid arthritis tests. It explains the common lab tests and imaging studies used to make an RA diagnosis. It also covers tests used to monitor disease progression and how your medication is working.
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What Is Rheumatoid Arthritis?
Rheumatoid arthritisis an autoimmune disease that causes your immune system to attack the healthy tissues and cells in your body.
RA damages the joints, causing inflammation (swelling) and pain in the wrists, hands, knees, and ankles. A progressive degenerative disease, RA can also affect other parts of the body, such as the eyes, heart, or lungs.
Symptomscan vary from person to person, but some early signs of RA include pain and tenderness in the joints. Over time, symptoms may get worse and progress to redness, stiffness, and swelling in the joints. Some people also have a low-grade fever and fatigue.
The exactcause of RAis not known, but several factors increase the risk of having this disease. It occurs more often in older adults and women. Smoking and being overweight also raise the risk of having RA. Certain genes have been linked to a higher chance of developing RA.
Blood Tests to Diagnose Rheumatoid Arthritis
There is no one specific test that conclusively diagnoses RA. Instead, your healthcare provider will make a diagnosis based on several tests including:
A combination of positive tests that show inflammation and antibodies associated with RA can help your healthcare provider reach a diagnosis.
Rheumatoid Factor (RF)
Rheumatoid factor (RF) is an antibody, which is a type of blood protein your immune system makes. Rheumatoid factor is part of the immune system’s attack on healthy tissues and cells in the body that causes inflammation. It is possible to measure RF with a blood test.
Since about 80% of adults with RA have rheumatoid factor, it is a common blood test during the diagnosis process.
However, the RF blood test on its own is not enough to make a diagnosis because you may have RA without RF in your blood. In addition, some people have a positive RF blood test because of other conditions and not RA.
You do not need to make any special preparations before the blood test. During the RF blood test, a healthcare professional will collect blood from your vein and put it in a test tube.
A laboratory will test your blood to check for the presence of rheumatoid factor. The blood test is a low-risk procedure that should not have any serious side effects.
Rheumatoid Factor Test: What to Expect
A positive RF blood test means that you have rheumatoid factor in your body. This indicates that you may have RA or another autoimmune condition.
A positive RF blood test is not a definitive diagnosis for RA. A negative RF blood test does not automatically mean you do not have RA. Some people with RA have negative RF blood tests. Your healthcare provider will order more tests before diagnosing RA.
Anti-Cyclic Citrullinated Peptide (Anti-CCP)
Anti-cyclic citrullinated peptide (anti-CCP) is a type of antibody found in the blood that can be measured with a blood test. Its other names include citrulline antibody, cyclic citrullinated peptide antibody, anticitrullinated peptide antibody, and ACPA.
Similar to rheumatoid factor, anti-CCP is part of the immune system’s attack on healthy cells in the body that causes inflammation.About 75% of adults with RA have anti-cyclic citrullinated peptides in their blood. It is rare for a person without RA to have anti-CCP.
Your healthcare provider may order the anti-CCP test along with the rheumatoid factor blood test during the RA diagnosis process. If you test positive for both antibodies, there is a strong chance you have RA.
A healthcare professional will collect your blood from your vein during an anti-CCP blood test. The blood sample will go to a laboratory, which will check for the presence of anti-cyclic citrullinated peptide. The anti-CCP blood test is a low-risk procedure that does not have any side effects.
A positive anti-cyclic citrullinated peptide blood test means you have these antibodies in your blood and may have RA. A negative anti-CCP blood test means you do not have the antibodies, but you may still have RA.
A positive anti-CCP and positive RF blood test indicate there is a strong chance you have RA. A positive anti-CCP and negative RF blood test show that you may be in the early stages of the disease or may have it in the future.
A negative anti-CCP and negative RF blood test mean you may not have RA, so your healthcare provider may order more tests.
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Erythrocyte Sedimentation Rate (ESR)
Erythrocytes are red blood cells. An erythrocyte sedimentation rate (ESR) is a blood test that measures how fast the red blood cells settle to the bottom of a test tube.
If the red blood cells settle quickly, then you may have inflammation in your body. Inflammation can make erythrocytes clump together, which makes it easier for them to settle in a test tube.
You do not need to do anything special to prepare for the blood test. When you have an ESR blood test, your blood will be collected from a vein and placed in a test tube. A laboratory will measure the erythrocyte sedimentation rate.
ESR Test: What to Expect
An ESR test cannot diagnose a specific disease. It can only show if there is inflammation in your body.
A high erythrocyte sedimentation range means that there is more inflammation in your body, and you may have an autoimmune condition, infection, or cancer. A moderately increased ESR can be observed with anemia, infection, menstruation, or pregnancy. A normal ESR helps exclude inflammation, particularly chronic inflammation.
If you have a high or moderate ESR blood test result, then your healthcare provider may order additional tests to check for RA. The ESR test is rarely done on its own to diagnose RA.
C-Reactive Protein (CRP)
Your liver makes C-reactive protein (CRP). The levels of CRP increase when there is inflammation in your body. It is possible to measure CRP levels with a blood test.
Similar to the ESR test, CRP cannot definitively diagnose RA or another autoimmune condition. Instead, healthcare providers use these tests to determine if there is inflammation in the body and if additional testing is necessary.
During the CRP test, your blood will be collected from a vein, so it can be analyzed. You do not need any special preparations before the test. It is a low-risk procedure without side effects.
CRP Blood Test: What to Expect
A high C-reactive protein blood test shows that you have inflammation in the body. A low CRP blood means it is less likely there is inflammation in the body.
Even if you have a high CRP test result, this does not automatically mean you have RA. You may have an infection or another inflammatory disease. Being overweight, smoking, and not exercising can also lead to high C-reactive protein levels. Your healthcare provider will order more tests if the results are positive.
Antinuclear Antibody (ANA)
An antinuclear antibody (ANA) is a protein that your immune system makes. It is called antinuclear because it attacks the nucleus (center) of a cell.
Antinuclear antibodies can damage healthy tissues and cells in the body. An ANA test measures the antinuclear antibodies in your blood to determine if you have an autoimmune disorder.
The antinuclear antibody blood test cannot show if you have a specific disease, like RA. However, healthcare providers often order the ANA test to investigate other autoimmune diseases that can cause arthritis, such as lupus. It is a step toward diagnosis.
You do not need to prepare for an ANA test. During the test, a healthcare provider will collect blood from your vein, so it can be analyzed in a lab.
ANA Blood Test: What to Expect
A positive ANA test means you have antinuclear antibodies in your body. A negative ANA test indicates that you do not have these antibodies.
A positive test is not a definitive diagnosis of RA. You may have another autoimmune condition or an infection that causes the positive results. Your healthcare provider will order other tests before diagnosing RA.
Complete Blood Count (CBC)
A complete blood count (CBC) is a test that looks at all the different cell types in your blood. Your healthcare provider may order a CBC test with differential and platelet counts during the RA diagnosis process to see if there is inflammation or other problems.
A CBC test can measure:
Blood will be collected from your vein during a CBC test. The sample will go to a laboratory for testing. A CBC test does not give a definitive diagnosis for RA.
CBC Blood Test: What to Expect
A CBC test will show the measurements of the different blood components, but not all of them are relevant for RA. Low white blood cell counts can indicate an autoimmune condition, cancer, or bone marrow problems. High white blood cell counts can mean you have an infection or inflammation.
A high white blood cell count can indicate you may have a condition like RA, but it is not a definitive diagnosis. Your healthcare provider will request other tests.
Other Tests
To rule out the possibility of other autoimmune conditions, your healthcare provider may take additional blood work, such as:
Imaging Tests to Diagnose Rheumatoid Arthritis
Your healthcare provider may also order imaging tests during the diagnosis process to evaluate joint damage. This commonly includes:
Less common imaging tests that are sometimes used to diagnose RA include:
You may have an X-ray, magnetic resonance imaging (MRI), or ultrasound scans to look for damage in your joints. After diagnosis, you may continue to have imaging tests to check if treatment is working and to see how the disease is progressing.
Tests to Monitor Rheumatoid Arthritis
After diagnosis, your healthcare provider will monitor the progression of the disease and how treatment is working. This will include blood, urine, and imaging tests.
Lab tests used for both diagnosis and monitoring of RA include ESR, CRP, and CBC.
RA disease activity is also monitored with a blood test called multi-biomarker disease activity (MBDA). This test checks for proteins, hormones, and growth factors and provides a disease activity score that indicates disease activity.
Since RA and RA medications can affect other organs, your provider may order additional lab tests to monitor the following:
Medications used to treat rheumatoid arthritis may increase the risk of infection. Your healthcare provider may monitor you more closely for infections as well.
Imaging tests used to monitor joint damage resulting from inflammation are often the same as those used to diagnose RA, including:
Summary
RA is diagnosed using blood tests and imaging studies. There is no single blood test that can provide a definitive diagnosis for RA. Thus, your healthcare provider will order multiple tests and also check your symptoms and medical history.
A combination of positive tests that show inflammation and antibodies associated with RA, along with imaging tests like X-rays, are used to reach a diagnosis.
© Verywell, 2018
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.Arthritis Foundation.Rheumatoid Arthritis: Causes, Symptoms, Treatments and More.Centers for Disease Control and Prevention.Rheumatoid arthritis (RA).Rheumatoid Arthritis Support Network.RF test: What is the normal range for a rheumatoid factor test?U.S. National Library of Medicine: MedlinePlus.Rheumatoid factor (RF) test.U.S. National Library of Medicine: MedlinePlus.CCP antibody test.U.S. National Library of Medicine: MedlinePlus.Erythrocyte sedimentation rate (ESR).U.S. National Library of Medicine: MedlinePlus.C-reactive protein (CRP) test.U.S. National Library of Medicine: MedlinePlus.ANA (antinuclear antibody) test.U.S. National Library of Medicine: MedlinePlus.Complete blood count (CBC).National Institute of Arthritis and Musculoskeletal and Skin Diseases.Diagnosis of rheumatoid arthritis.Arthritis Foundation.Testing for rheumatoid arthritis.
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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.Arthritis Foundation.Rheumatoid Arthritis: Causes, Symptoms, Treatments and More.Centers for Disease Control and Prevention.Rheumatoid arthritis (RA).Rheumatoid Arthritis Support Network.RF test: What is the normal range for a rheumatoid factor test?U.S. National Library of Medicine: MedlinePlus.Rheumatoid factor (RF) test.U.S. National Library of Medicine: MedlinePlus.CCP antibody test.U.S. National Library of Medicine: MedlinePlus.Erythrocyte sedimentation rate (ESR).U.S. National Library of Medicine: MedlinePlus.C-reactive protein (CRP) test.U.S. National Library of Medicine: MedlinePlus.ANA (antinuclear antibody) test.U.S. National Library of Medicine: MedlinePlus.Complete blood count (CBC).National Institute of Arthritis and Musculoskeletal and Skin Diseases.Diagnosis of rheumatoid arthritis.Arthritis Foundation.Testing for rheumatoid arthritis.
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.
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U.S. National Library of Medicine: MedlinePlus.CCP antibody test.
U.S. National Library of Medicine: MedlinePlus.Erythrocyte sedimentation rate (ESR).
U.S. National Library of Medicine: MedlinePlus.C-reactive protein (CRP) test.
U.S. National Library of Medicine: MedlinePlus.ANA (antinuclear antibody) test.
U.S. National Library of Medicine: MedlinePlus.Complete blood count (CBC).
National Institute of Arthritis and Musculoskeletal and Skin Diseases.Diagnosis of rheumatoid arthritis.
Arthritis Foundation.Testing for rheumatoid arthritis.
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