How is early rheumatoid arthritis diagnosed?

Photo of a painful hand (PantherMedia / Alice Day)

It can be difficult to diagnose rheumatoid arthritis early on in the disease. In the first few weeks and months, the symptoms are often mild and not always typical. But it's still important to try to diagnose and treat rheumatoid arthritis as soon as possible. It is thought that early treatment helps to stop the progression of the disease.

Some of the non-specific symptoms include general weakness, exhaustion, tiredness and weight loss. Other early signs include a slight fever, as well as achy bones and muscles. But people might also experience more typical rheumatoid arthritis symptoms such as swollen joints.

If you're concerned about non-specific symptoms, you can see a doctor. Tests specifically for rheumatoid arthritis will be recommended at the latest if

  • three or more joints have been swollen for at least six weeks,
  • the same joints are swollen on both sides of the body, and/or
  • your joints feel stiff for at least one hour each morning.

How are early stages of rheumatoid arthritis diagnosed?

If there are signs that someone may have rheumatoid arthritis, the following diagnostic tools can be used to try to find out for sure:

  • Blood test for antibodies: Specific kinds of antibodies in your blood can be a sign of rheumatoid arthritis. These include antibodies called rheumatoid factors and "antibodies to citrullinated protein antigens" (ACPA).
  • Blood test for signs of acute inflammatory reactions: One thing that can be looked for is C-reactive proteins (CRPs). If there is an inflammation in the body, more of these proteins are released. The erythrocyte sedimentation rate (ESR) can reflect the degree of inflammation in the body too. This is a measure of how long it takes for red blood cells to settle at the bottom of a test tube. Faster-sinking red blood cells are a sign of inflammation.
  • Imaging techniques: Ultrasound scans or x-ray pictures can help doctors to see whether joints have already changed. Sometimes techniques such as magnetic resonance imaging (MRI) or bone scintigraphy are used too. But there are often no visible changes to joints in early stages of rheumatoid arthritis.

Inflamed joints or abnormal blood test results alone do not allow for a reliable diagnosis of early rheumatoid arthritis. They might be caused by something else instead. The more signs of rheumatoid arthritis someone has, the likelier they are to actually have the disease.