Diagnosis

Diagnosing RA is challenging even during its early stages due to the variety of symptoms; many appearing similar to other arthritic disorders characterized with intense pain. A rheumatologist, specializing in diseases of connective tissue and joints typically is the one to diagnose and prescribe long-term management approaches. A physical examination, discussion of symptoms, x-rays (Figure 7) and a blood test comprise an essential diagnostic work-up. X-rays may not clearly identify bone changes in early stages; whereas ultrasound and magnetic resonance imaging (MRI) provides greater sensitivity in detecting early joint damage and erosions.⁶⁶ Immunological testing determines the presence of a specific antibody, rheumatoid factor (RF), identified in approximately 80% suffering with RA after one year.⁶⁷ Rheumatoid factor-positive patients may also have a higher disease activity score, meaning frequent flare-ups and fewer remission periods.⁶⁸

Figure 7. X-ray of patient with Rheumatoid Arthritis.

Figure 7. X-ray of patient with Rheumatoid Arthritis.

RA is a disabling disease with most daily activities impaired. At least 50% of those diagnosed ten years from onset are unable to maintain full time employment. Those diagnosed before age 45 encounter greater disabilities than those diagnosed at 70+.⁵⁸

Figure 8. 2010 Rheumatoid Arthritis Classification.⁶⁹

Figure 8. 2010 Rheumatoid Arthritis Classification.⁶⁹