Rheumatoid arthritis is an autoimmune disease that causes inflammation and damage to the joints and other parts of the body. It most commonly affects the small joints in the hands and feet but can affect any joint in the body. Diagnosing rheumatoid arthritis early and accurately is important for effective disease management and preventing joint damage. Here are some of the key diagnostic tests that doctors use to diagnose rheumatoid arthritis:
Medical History and Physical Exam
The diagnosis of rheumatoid arthritis usually begins with a detailed medical history and physical examination by a rheumatologist. The doctor will ask about the joints affected, symptoms, duration of symptoms and family history of autoimmune diseases. In the physical exam, the doctor examines the joints for swelling, tenderness, warmth, redness and limited range of motion. The pattern and symmetry of joints affected can provide clues to rheumatoid arthritis. The medical history and physical exam allows the doctor to determine if further testing is needed.
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Blood Tests
Several blood tests are used to help diagnose rheumatoid arthritis and determine disease activity.
Rheumatoid Factor (RF): Rheumatoid factor is an antibody that is present in about 80% of people with RA but can also be present in some other conditions. While not specific to RA, a positive RF result adds to the likelihood of a diagnosis.
C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR): CRP and ESR are measures of systemic inflammation in the body. Elevated levels of either provide supportive evidence of an inflammatory disease like RA but are not specific.
Anti-CCP Antibody Test: Anti-CCP stands for anti-cyclic citrullinated peptide antibody. This relatively new antibody test is one of the most specific for RA, being present in around 60-70% of people with the disease. A positive anti-CCP result strongly hints at a diagnosis of RA.
Complete Blood Count: This test checks for anemia, infection and other abnormalities that could be contributing factors. Anemia of chronic disease is common in RA.
Kidney and Liver Function Tests: Rheumatoid arthritis can potentially affect the kidneys and liver, so baseline tests are obtained.
Imaging Tests
Imaging tests are used to detect and monitor joint damage from RA. They include:
X-rays: X-rays can show early bone erosion and joint space narrowing characteristic of rheumatoid arthritis. It remains an important longitudinal tool.
Ultrasound: Ultrasound is very useful for detecting inflamed, swollen joint tissues in the small joints of hands and feet where physical exam may be limited. It is becoming a preferred first-line imaging method.
MRI: MRI is more sensitive than x-ray or ultrasound for detecting inflammatory changes in soft tissues, bone and cartilage. It is especially helpful for evaluating wrist, hand and foot joints.
Other Tests
Other tests sometimes used include:
Pulmonary Function Tests: Rheumatoid arthritis can potentially affect the lungs.
Eye Exam: Inflammation of tissues around the eyes (conjunctivitis, keratitis, episcleritis, scleritis) can occur in RA patients.
Nerve Conduction Studies: Carpal tunnel syndrome and other entrapment neuropathies are associated with RA.
The pattern of results from medical history, physical examination, blood tests, imaging and other tests aids the rheumatologist in making a definite diagnosis of rheumatoid arthritis or determining if another condition is present. An accurate diagnosis allows appropriate treatment planning to prevent long-term joint damage from this chronic autoimmune disease.
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Diagnosis Challenges
While diagnostic tests help identify rheumatoid arthritis, there are still some challenges in arriving at a definite diagnosis. Some patients may have inconclusive or nonspecific results in the early phases when the disease is just developing. Tests like RF, anti-CCP and inflammatory markers can be negative in up to 30% of people who ultimately develop definite RA based on clinical progression. Imaging findings take time to appear after joint symptoms start. Making the diagnosis can be complex in patients with overlapping musculoskeletal conditions or in elderly patients where attributing joint symptoms may be difficult. A high index of suspicion and follow up testing is important in ambiguous cases to detect and treat RA as early as possible.
Conclusion
Rheumatoid arthritis is a potentially debilitating disease if left unmanaged. A prompt, accurate diagnosis is key to effective medical management and prevention of joint damage. An astute clinical evaluation combined with strategic use of readily available blood tests, imaging and other diagnostic studies provides the tools needed for diagnosis. Despite challenges, the rheumatologist utilizes these tests as pieces of evidence to establish or rule out rheumatoid arthritis. Early diagnosis facilitates timely treatment intervention to control symptoms, prevent disability and improve overall outcomes for patients with this chronic autoimmune disorder.
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Government and private insurance companies providing reimbursement for the treatment of RA will be a market booster.
Continued R & D of biomarker-based diagnostic tests and commercialization of reliable, cost-effective test kits will create lucrative opportunities for this market's growth.
The availability of a broad range of test kits to diagnose the inflammation will support market growth.
