During the physical exam, the doctor will be looking for such indicators as joint swelling and tenderness, loss of motion in your joints, and joint malalignment. Signs of RA can also show in organs including skin, lungs and eyes.
While there is no one lab test that will diagnose or rule-out RA, the doctor will use test results in conjunction with the patient history and physical exam to arrive at a diagnosis.
Lab Tests
Complete Blood Count (CBC)
A CBC tests for abnormalities in the three types of cells in your blood.
- Red blood cellscarry oxygen to tissues; RA patients often have a low red blood count which results in anemia and contributes to extreme fatigue.
- White blood cells help fight infections and may be high in RA patients, signaling that infection is present.
- Platelet counts are elevated when inflammation is present in the body. It can also be lowered by certain drugs.
Erythrocyte Sedimentation Rate (ESR or sed rate)
This test measures the speed that red blood cells fall to the bottom of a test tube; the faster the red blood cells drop, the higher the rate of inflammation in the patient.
C-Reactive Protein
Much like the ESR test, the C-reactive protein (CRP) measures the degree of inflammation, sometimes one will be raised when the other isn’t.
Rheumatoid Factor (RF)
Seventy to 80 percent of people with rheumatoid factor (RF) also have rheumatoid arthritis. The presence of RF rises according to the severity of the disease.
Antinuclear Antibodies (ANA)
According to the Arthritis Foundation, “this test detects a group of autoantibodies (antibodies against self), which is seen in about 30 to 40 percent of people with RA. Although it commonly is used as a screening tool, ANA testing isn't used as a diagnostic tool because many people without RA or with other diseases can have ANAs.”
Imaging
X-rays
When you first visit the doctor, he may take x-rays to set a baseline for comparison with future x-rays. These images will show how the disease is progressing by showing small holes near the ends of bones and loss of cartilage.
Magnetic Resonance Imaging (MRI)
This test can detect early inflammation better than an x-ray. It can pinpoint synovitis (inflammation of the lining of the joint).
Bone Densitometry (DEXA)
Bone densitometry is important for measuring bone density, used primarily to detect osteoporosis. Osteoporosis may be especially severe in people with RA due to joint immobilization.
Upon reviewing the results of lab test and images, the doctor will discuss treatment options with the patient. Treatment will usually begin with prescription treatment but may progress to injections and surgery as the disease progresses.
It is important for the RA patient to feel confident and comfortable with his/her physician, to adhere to the treatments prescribed, to get plenty of rest, and--most importantly--to observe daily exercise regimens.
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