Diagnosing Rheumatoid Arthritis

There are a number of different diseases which fall under the broad term of Arthritis with Rheumatoid Arthritis (RA) being the second most common, affecting about 400,000 Australians and 40,000 New Zealanders 

A chronic, progressive auto-immune disease, RA is the result of your body’s immune system attacking the tissues of the joints, causing pain and inflammation. RA can cause permanent damage to joints, especially in the early years of the disease. So if you believe you may be displaying the symptoms of RA, it is important to see your GP as soon as possible.

Some of the initial signs to look out for are:

• Pain, swelling and redness around your joints, usually beginning in the hands and feet.
• Stiff joints first thing in the morning or after a period of inactivity.
• Chronic fatigue.

These symptoms are not exclusive to RA which can make it difficult to diagnose, particularly since many people will often blame other factors such as overdoing a physical activity. There is also no single, simple test for RA and the symptoms can come and go so a GP may look for other causes first.

Diagnostic tests

If your doctor suspects RA then he or she can carry out a few different tests that give an indication of the presence of RA. Your GP may do this either before or alongside referring you to a Rheumatologist.

• ESR test
  ​​​​​​​The Erythrocyte sedimentation rate (ESR) test uses a sample of red blood cells and times how quickly they fall to the bottom of a test tube. Inflammation causes red blood cells to clump together and so they will descend quicker.
• CRP test
  ​​​​​The C-reactive protein (CRP) test measures a protein produced by the liver which is elevated when the body is suffering from inflammation.
• Full blood test
  ​​​​​​​A full blood cell count will be used to identify whether you are suffering from anaemia, a condition where the blood cannot carry enough oxygen due to low levels of red blood cells. Eight out of 10 RA sufferers are anaemic but that itself has many causes including dietary so it doesn’t prove the presence of RA.
• Rheumatoid factor
  ​​​​​​​Doctors can test for an antibody called the rheumatoid factor in your blood but confusingly about 20 per cent of RA sufferers do not display it and it can be detected in people with other diseases. Another antibody test for anti-CCP (anti-cyclic citrullinated peptide antibody) is more specific to RA.
• Examination and imaging
  ​​​​​​​A rheumatologist is trained to spot synovitis, the swelling and redness in joints that is characteristic of RA and can be difficult for a less specialised healthcare professional to identify. X-rays, ultrasounds and magnetic resonance imaging (MRI) scans can help distinguish between different types of arthritis, identify inflammation and assess what damage has been done to joints.

A rheumatologist will also be able to discuss your symptoms with you and assess any other factors that may indicate RA such as a genetically increased susceptibility, exposure to environmental triggers (an infection, trauma or stress) and smoking.

Treatment

There is currently no known cure for RA but it is the focus of a lot of research. Early diagnosis can help mitigate and control the symptoms.

In fact, the goal of RA treatment is to help get you to a state of clinical remission, that is a total absence of symptoms; if this is not possible, then the lowest level of disease activity. While this doesn’t always happen, many people who are treated early on may be able to get to a state of low or very low disease activity.

A class of drugs called Disease modifying anti-rheumatic drugs (DMARDs) can reduce joint damage. Steroids, pain killers and anti-inflammatory drugs can also help contain the symptoms while regular moderate exercise and physiotherapy can make the disease easier to live with.

So if you believe you might have some of the symptoms it is important to see your doctor as soon as possible.