How is early rheumatoid arthritis diagnosed?

Photo of someone holding their hand in pain

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 important to diagnose the disease as soon as possible: The treatment is more likely to stop rheumatoid arthritis from getting worse if it is started early enough.

Some of the non-specific symptoms of early rheumatoid arthritis 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.

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 after getting out of bed in the 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.

If these tests suggest that it is likely to be rheumatoid arthritis, further examinations (including imaging techniques) can be used. These include:

Ultrasound: Ultrasound scans can help doctors to see early signs such as inflammations and a build-up of fluid, as well as an increased blood supply to the mucous membranes in the joint.
X-rays: X-ray images can show whether the bone or cartilage of the joint has already been damaged.
Magnetic resonance imaging (MRI): MRI images allow doctors to get a very clear picture of bones, joints, tendons and muscles. But they often find abnormalities that don't have anything to do with 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 more likely they are to actually have the disease.

Deutsche Gesellschaft für Rheumatologie (DGRh). Management der frühen rheumatoiden Arthritis (S3-Leitlinie). AWMF-Registernr.: 060-002. December 18, 2019.

National Institute for Health and Care Excellence (NICE). Rheumatoid Arthritis. National clinical guideline for management and treatment in adults. July 11, 2018. (NICE Guidelines; Volume NG100).

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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