How is Rheumatoid Arthritis Diagnosed? | Johns Hopkins Rheumatology

Summary

This video explains rheumatoid arthritis (RA), highlighting that the condition varies from person to person and is more common in women, typically affecting those in their forties and fifties. A rheumatologist diagnoses RA through medical history, physical exams, and blood tests like rheumatoid factor and anti-CCP antibodies. Imaging tests such as x-rays and ultrasounds help assess joint damage. Regular monitoring helps track disease progression. Early treatment is essential to prevent joint damage, and understanding individual symptoms is key to effective management.

Takeaways

• 👩‍⚕️ Rheumatoid arthritis (RA) does not present the same way in all individuals and is more common in women, usually appearing in people in their 40s and 50s.
• 🔬 A rheumatologist typically diagnoses RA through a combination of medical history, physical examination, blood tests, and sometimes imaging like X-rays.
• 🦴 During the physical exam, a rheumatologist examines joints for swelling and pain, counting the number of affected joints. This exam is repeated to assess treatment effectiveness.
• 🩸 Blood tests like rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody, ESR, and C-reactive protein (CRP) help diagnose RA and monitor inflammation.
• ❌ Not all RA patients will have positive RF or anti-CCP results. Those with negative results but RA symptoms are classified as having seronegative RA.
• ⏳ The duration of joint pain and swelling, typically around six weeks, is crucial for diagnosing RA.
• 🩺 A detailed medical history is essential to identify other conditions that may impact RA treatment or diagnosis.
• 📊 Imaging tests like X-rays, ultrasound, or MRI can reveal joint damage and monitor disease progression, helping adjust treatment plans.
• ⚠️ RA is a progressive disease that can worsen over time without treatment, with significant damage occurring within the first two years.
• 🏥 Early diagnosis and treatment are critical to slowing disease progression and preventing irreversible joint damage.

Q & A

What is rheumatoid arthritis (RA) and who is most commonly affected?

Rheumatoid arthritis is an autoimmune disease that causes pain and swelling in the joints. It is more common in women and typically begins in people in their forties and fifties, although it can start at any age.

How is rheumatoid arthritis diagnosed?

RA is usually diagnosed by a rheumatologist through a combination of a detailed medical history, physical exam, blood tests, and possibly imaging like x-rays or ultrasound. The diagnosis often involves ruling out other causes of symptoms.

What is the purpose of the physical exam in diagnosing RA?

During the physical exam, a rheumatologist checks the joints for swelling and pain. They perform a joint count to see how many joints are involved. This exam helps assess the severity of RA and monitor treatment effectiveness in future appointments.

How long do symptoms need to persist before RA is considered a likely diagnosis?

Symptoms of joint pain and swelling typically need to persist for about six weeks before RA is considered a possible diagnosis.

What blood tests are used to help diagnose RA?

Several blood tests are used, including the rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). These tests help assess inflammation and the presence of specific markers for RA.

What is the difference between rheumatoid factor and anti-CCP in diagnosing RA?

The rheumatoid factor is found in about 75% of RA cases, but can also be present in other conditions. Anti-CCP is more specific to RA and indicates a higher likelihood of a more aggressive form of the disease.

What is seronegative RA?

Seronegative RA refers to cases where a person has RA symptoms but tests negative for both the rheumatoid factor and anti-CCP antibodies. Diagnosis is based on symptoms alone in these cases.

How do ESR and CRP help in managing RA?

Both ESR and CRP are markers of inflammation. They are regularly checked to monitor how active RA is and to evaluate how well treatment is controlling the disease.

Why is early treatment important in RA?

Early treatment is crucial because RA is progressive and can cause joint damage, especially in the first two years. Starting treatment early helps slow the damage and prevent long-term joint erosion.

What imaging techniques are used to assess joint damage in RA?

X-rays, ultrasound, and sometimes MRI are used to check for joint damage. Ultrasound can detect even small amounts of inflammation that can't be felt and can help monitor soft tissue and tendon swelling.

Outlines

00:00

🧑‍⚕️ Understanding Rheumatoid Arthritis Diagnosis

Rheumatoid arthritis (RA) is more common in women and typically begins in the forties or fifties, though it can start at any age. A rheumatologist usually diagnoses RA through a combination of your medical history, physical examination, blood tests, and sometimes imaging. Diagnosis is often achieved by ruling out other conditions. Key elements of the physical exam include counting and feeling swollen or painful joints, particularly in the hands, wrists, and elbows. This examination continues during future visits to track your response to treatment. The duration of joint pain, typically at least six weeks, is crucial for RA diagnosis. A detailed health history is also gathered to assess associated conditions and determine the most appropriate medications. Patients may be asked about symptom onset, family history of autoimmune diseases, and how RA affects daily life, work, and leisure activities.

05:02

🩺 Blood Tests and Imaging for RA Monitoring

Several blood tests are used to help diagnose RA. The rheumatoid factor test is positive in about 75% of RA cases, though it may also be elevated in other inflammatory conditions. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are more specific to RA, with higher levels indicating a potentially more aggressive form of the disease. Not all RA patients test positive for rheumatoid factor or anti-CCP, and those with negative results are classified as having seronegative RA, diagnosed based on symptoms alone. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests measure inflammation and are regularly monitored to track disease activity. RA is progressive and can cause damage quickly, particularly in the first two years. Early treatment is essential to slow down joint damage. Rheumatologists may also use x-rays, ultrasounds, or MRIs to detect joint damage and monitor disease progression. These imaging techniques help visualize joint erosion and inflammation.

Keywords

💡Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA) is a chronic autoimmune disease that causes inflammation in the joints, leading to pain, swelling, and potential joint damage. The video highlights that RA affects people differently and is more common in women, often starting in the forties and fifties. It can progress if left untreated, causing severe joint damage, as explained through the examination and diagnostic processes.

💡Rheumatologist

A rheumatologist is a specialist doctor who diagnoses and treats arthritis and other musculoskeletal diseases. In the video, the role of the rheumatologist is central to diagnosing RA through a history of symptoms, physical exams, and various tests. They monitor the patient’s condition over time to adjust treatments and prevent joint damage.

💡Joint Count

A joint count is a physical examination performed by a rheumatologist to assess the number of painful and swollen joints in a patient with RA. In the video, this is mentioned as part of the diagnostic process, with the rheumatologist examining the hands, wrists, and elbows to track disease progression and treatment response.

💡Rheumatoid Factor

Rheumatoid factor is an antibody found in the blood of about 75% of RA patients, often used as a diagnostic tool. However, it can also be present in other inflammatory diseases. The video emphasizes that while a positive rheumatoid factor may indicate RA, it is not the sole determinant, as some RA cases may be seronegative.

💡Anti-Cyclic Citrullinated Peptide (Anti-CCP)

Anti-CCP antibodies are more specific to RA than rheumatoid factor and are used to help confirm the diagnosis. If elevated, these antibodies may indicate a more aggressive form of RA. The video mentions anti-CCP as a crucial test in distinguishing RA from other conditions, highlighting its importance in diagnosing more severe cases.

💡Seronegative RA

Seronegative RA refers to cases where a patient exhibits RA symptoms but does not test positive for rheumatoid factor or anti-CCP antibodies. The video explains that this form of RA is diagnosed based on symptoms rather than blood work, underlining the variability in RA presentation across different patients.

💡Erythrocyte Sedimentation Rate (ESR)

ESR is a blood test that measures inflammation in the body. In the video, it is used to monitor inflammation levels in RA patients, with elevated results indicating active disease. ESR is repeatedly checked during treatment to assess how well the disease is controlled.

💡C-Reactive Protein (CRP)

CRP is another marker of inflammation, similar to ESR, that rises when RA is active. The video describes CRP as part of the regular blood tests performed to monitor disease activity, helping guide treatment decisions. Like ESR, CRP levels are indicative of how effectively the disease is being managed.

💡X-ray and Ultrasound

X-rays and ultrasounds are imaging tools used to detect joint damage in RA. The video discusses how these methods help rheumatologists see damage to bones and cartilage caused by chronic swelling. They are used both for diagnosis and ongoing monitoring to ensure that treatment is preventing further deterioration.

💡Autoimmune Disease

RA is classified as an autoimmune disease, meaning the body's immune system mistakenly attacks its own tissues. The video mentions how autoimmune diseases like RA can run in families, and that part of the diagnostic process involves understanding if there is a family history of RA or other autoimmune disorders.

Highlights

Rheumatoid arthritis (RA) is more common in women and can begin at any age, but it's often seen in people in their forties and fifties.

RA diagnosis is typically made by a rheumatologist through a combination of history, physical exams, blood work, and possibly x-rays.

RA is often diagnosed by eliminating other possible causes of joint pain and swelling.

A joint count is performed during physical exams to assess the number of affected joints, and this exam is repeated during follow-up appointments.

Pain and swelling lasting for at least six weeks is a typical indicator of rheumatoid arthritis.

Blood tests, including rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP), are used to help diagnose RA.

Anti-CCP is more specific to RA than rheumatoid factor and indicates a more aggressive form of the disease.

Some RA cases are seronegative, meaning no positive blood tests but diagnosed based on symptoms.

The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood tests are used to monitor inflammation and track disease activity.

RA is progressive, meaning it worsens without treatment, particularly within the first two years of the disease.

Early treatment can slow the progression of RA and reduce long-term joint damage.

X-rays, ultrasounds, or MRIs may be used to check for joint damage, and these imaging tests are often repeated over time.

Ultrasound can detect even small amounts of inflammation and damage in joints that might not be visible in other tests.

RA symptoms and disease progression can vary greatly between individuals, requiring personalized management with a rheumatologist.

Continual monitoring through exams and blood tests helps track the effectiveness of treatment and manage RA.

Transcripts

(gentle piano music begins)

- Rheumatoid arthritis does not look the same in all people.

It's more common in women.

It can begin at any age,

but it's most often seen

in people in their forties and fifties.

The diagnosis of rheumatoid arthritis

is usually made by a rheumatologist.

Your history of pain and swelling,

a physical exam, blood work,

and maybe x-rays, as well,

they help determine the diagnosis.

Often RA is diagnosed by eliminating

or ruling out any other possible cause of your symptoms.

The first thing that happens is usually a history

and physical exam.

Your rheumatologist will examine your joints

for swelling and pain,

and then they count the number of joints that involved.

The exam consists of feeling all the joints of your hands,

wrists, elbows,

and this is called a joint count.

Sometimes joints are painful,

and they don't have noticeable swelling,

and sometimes joints are swollen, but there's no pain.

Your rheumatologist will do this examination

at all of your future appointments,

and this is how they can tell

how well you are responding to the treatment that you're on.

The length of time that you've been experiencing

this joint pain and swelling is also important.

So in rheumatoid arthritis,

this pain and swelling has typically been around

for about six weeks.

Your rheumatologist will also

get a detailed history of your health,

and so that has helped to help them understand

if you have other medical conditions

that might be associated with RA,

or might not, it's okay,

and if there are conditions that might impact

the kind of medications that you're going to be prescribed.

You might have to fill out other questions

or surveys about your health,

and so some of those might include:

When did the symptoms first begin?

Does anyone in your family have RA

or even another autoimmune disease?

How have these symptoms affected your ability to work?

How have they affected your ability

to do your daily activities?

How have they affected your ability

to participate in leisure activities?

So next there are several blood tests

that are used to help diagnose RA.

So the very first one is called a rheumatoid factor,

and the rheumatoid factor, it's useful to help diagnosis,

and about 75% of cases have a positive rheumatoid factor

over the course of the illness,

but a rheumatoid factor positivity

may be seen in other chronic inflammatory diseases as well,

so that's not the end all.

The next blood test is called

the anti-cyclic citrullinated peptide antibody,

anti-CCP, much easier to say,

is more specific than a rheumatoid factor.

It means it does not occur in other conditions besides RA.

If you have high levels of these antibodies,

the anti-CCP antibodies,

that could mean that you have a more aggressive form of RA.

Not all people will have a positive rheumatoid factor

or a positive anti CCP, or both,

and that's called seronegative RA,

which means you have RA by the symptoms only,

but not by the blood work.

The next thing we measure is called

the erythrocyte sedimentation rate, or ESR,

and that's used to measure inflammation in the blood,

and a lot of times we're going to see

that that's elevated in RA,

and this is going to be checked on a regular basis,

and again, it helps monitor how well

your disease is under control,

so you will get that test a lot in your future.

The C-reactive protein blood test

is another marker of inflammation,

and like the ESR,

it's often elevated when your RA is active.

And so, again, this is another blood test

that you will get often

to see how well your RA is controlled.

So RA is progressive,

and that means it gets worse with time

if you don't have treatment.

We have data that damage happens quickly,

especially in the first two years of having RA.

We know that if we can begin the treatment for RA early,

we can slow that damage.

Your rheumatologist might order x-rays or ultrasound,

or even MRI of your hands, wrists, and other joints

to see if any damage has already happened

because we know the swelling, chronic swelling,

may have caused cartilage and bone to erode.

X-rays may be done every couple years afterwards,

again, to make sure your disease is well controlled.

Ultrasound is another imaging technique

that can be useful in monitoring disease.

An ultrasound can see even small amounts of information

that can't be felt,

and it can see damage in the joints, as well as swelling

around the tendons and other soft tissues.

So you can see how RA may look different in each person

because some people may have all of the symptoms.

Some people may have only have some of the symptoms,

but it's important to work with your rheumatologist

to make sure this is your diagnosis.

(gentle piano music continues)