How is rheumatoid arthritis diagnosed

Rheumatoid arthritis: diagnosis

Rheumatoid arthritis: early diagnosis

Early diagnosis and rapid therapy are important in rheumatoid arthritis in order to bring the disease to a standstill as far as possible. There is no single test or laboratory value that can be used to determine the condition. Different examinations are done to make the diagnosis.

However, the various examination methods not only help with diagnosis. As the disease progresses, regular check-ups can be used to check how the rheumatoid arthritis is developing and whether the treatment is working.

Treatment by the rheumatologist

An internal rheumatologist is the right specialist for the diagnosis and treatment of rheumatoid arthritis:

  • He specializes in inflammatory rheumatic diseases.
  • He can carry out all the necessary examinations.
  • He knows all the treatment options and can initiate the appropriate therapy.

Doctor search: the rheumatologist you trust

Finding the right therapy for the individual and achieving therapy goals should be a partnership with the treating rheumatologist. In addition to technical knowledge, a trusting relationship is important for this.

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Rheumatoid Arthritis Studies

Conversation and physical examination

  • The first step towards diagnosis is a detailed discussion with the rheumatologist. He asks about the medical history (anamnesis), for example when the symptoms began or whether rheumatic diseases are known to other family members. During the physical exam, palpation of the joints can determine whether joints are swollen or tender. The mobility of the joints is also checked.

Laboratory tests

  • Different blood counts can provide clues to a diagnosis of rheumatoid arthritis and whether there is inflammation going on in the body.
  • Protein that is increasingly formed in the body when there is inflammation.
  • An increased occurrence in the blood can indicate inflammation.
  • This value shows how quickly the red blood cells in a blood sample drop.
  • An increased ESR can be an indication of inflammation in the body.
  • Rheumatoid factor is an antibody that can be detected in the blood in some rheumatic diseases.
  • If it is present, the disease is rheumatoid factor positive. If not, rheumatoid factor negative.
  • Many of the people with rheumatoid arthritis have rheumatoid factor positive.
  • Other diseases of the musculoskeletal system can also be rheumatoid factor positive.
  • Antibodies against the cyclic citrullinated peptide, a protein that can be released in rheumatoid arthritis.
  • If this antibody is detected, it can be an indication of rheumatoid arthritis.

Imaging procedures

Imaging tests show what the inside of the joint looks like.

Changes in the bone become visible on X-rays (structural changes). However, bone damage usually only occurs in the later course of rheumatoid arthritis.

Ultrasound waves can detect inflammation and changes in cartilage, bones, tendons or tendon attachments. These are usually already visible in the early stages of the disease.

MRI, also known as magnetic resonance imaging, makes inflammatory changes in cartilage, bones and tendons visible in the early stages of rheumatoid arthritis.

Calculation of disease activity

With different point values, so-called scores, a uniform assessment of the disease activity in rheumatoid arthritis is possible. For this purpose, individual characteristics of the disease are used, for example the number of tender and swollen joints. The patient's self-assessment of their own disease activity is also frequently asked for in questionnaires. There is no right or wrong. It is important to be honest about how the disease and its consequences are felt.

If a score is calculated over and over again, its change can show how the disease is progressing or whether the therapy is working.

    • Detects rheumatoid arthritis disease activity.
    • Is calculated from:
      • the number of swollen joints
      • the number of tender joints
      • Blood counts that show inflammation (CRP and ESR)
      • the patient's self-assessment of disease activity
    • The self-assessment of the disease activity is carried out with the visual analog scale
      (VAS): How the disease was felt in the last 7 days is drawn on a 100 mm long line
  • The value can be between 0 and 10:
    • below 2.6 = remission (almost complete freedom from inflammation and symptoms)
    • 2.6 to 3.1 = low disease activity
    • 3.2 to 5.0 = mean disease activity
    • From 5.1 = high disease activity
  • Detects functional restrictions in everyday activities
  • Contains 18 questions to be answered by the patient
  • Examples: Can you write by hand? Can you put on and take off stockings?
  • Detects functional restrictions in everyday activities
  • Questions are answered by the patient
  • Questions are asked about restrictions in the areas of dressing and personal hygiene, getting up, eating, walking, aids and aids, lifting and gripping

Measure pain

The so-called visual analog scale (VAS) is often used to record the extent of pain. To do this, it is marked on a 10 cm long line how severe the pain is felt.

Sources: Fransen J, van Riel PL. The Disease Activity Score and the EULAR response criteria. Rheum Dis Clin North Am 2009; 35 (4): 745-757.
Bengel J, Wirtz M, Zwingmann C (Eds.). Diagnostic procedures in rehabilitation. Göttingen: Hogrefe, 2008.