Everything To Know About Rheumatoid Arthritis Diagnosis And Treatment
When people have rheumatoid arthritis, their immune system attacks the tissues in their joints. Over time, this creates pain and inhibits movement. Over two million Americans have rheumatoid arthritis (RA). But how do they know that they have this chronic auto-immune disorder?
Most patients develop RA as they age, and it can be hard to diagnose. Learn how doctors find RA, all the tests they need, and what you should know heading into the doctor's office. Here's everything you need to know about rheumatoid arthritis diagnosis and treatment.
How Doctors Determine Rheumatoid Arthritis
According to the American College of Rheumatology, patients must meet six criteria to be diagnosed with RA officially. First, symptoms must affect more than one joint. The symptoms must also last for at least six weeks to confirm that it's a chronic condition.
Second, patients must test positive on a couple of blood tests. They must also test positive on a C-reactive protein or erythrocyte sedimentation test. Although this sounds like overkill, all of these steps are essential.
What Causes Rheumatoid Arthritis?
According to Cleveland Clinic, scientists still don't know what causes rheumatoid arthritis. Certain risk factors, such as age and hormones, increase a person's likelihood of the disease. But these don't cause RA; they only contribute.
During rheumatoid arthritis, the immune system targets the joints. Some experts believe that this happens when excess inflammation triggers a hyperactive immune system. But despite the theories, anyone can get rheumatoid arthritis for any number of reasons. The causes are unclear.
Expect Blood Tests
According to the Rheumatoid Arthritis Support Network, every patient should expect at least one blood test. Usually, doctors conduct three tests to determine whether someone has the condition. These tests don't confirm a diagnosis, but they're essential for the process, says the Johns Hopkins Arthritis Center.
The ESR and CRP blood tests search for inflammation in the joints. The Rheumatoid Factor test pinpoints antibodies that often appear in RA, and Anti-CCP looks for autoantibodies present in the disease.
Imaging Tests
Imaging tests tell doctors how much damage has happened to patients' bones and joints. The most common test is an X-Ray, which portrays any harm done to the tissues and bones. A Computed tomography scan (or CT scan) uses special X-Ray equipment to zoom in on certain areas, says Stanford Health Care.
In rare cases, doctors may use magnetic resonance imaging (MRI) and a bone scan to view your joints more clearly, but these are usually used to detect other conditions.
Inflammation Tests
Two RA tests hunt for inflammation in the body. One is a C-reactive protein (CRP) test. Since the liver produces CRP during high levels of inflammation, it often indicates RA. Medications change CRP rates, so doctors sometimes use this test to ensure that the medicine is working.
Second, there's the erythrocyte sedimentation rate (or ESR) test. When inflammation occurs, red blood cells clump together. An ESR test examines the red blood cells to determine how much inflammation is in the body.
Searching For Anemia
Your doctor may search for signs of anemia, or a lack of red blood cells. According to the Archives of Rheumatology, up to 70% of RA patients also have anemia. "Anemia can occur in people who have ongoing inflammation in their body, including rheumatoid arthritis," says Dr. Sioban Keel, an associate professor of hepatology.
The inflammation interferes with the body's absorption of iron, which can cause anemia. Some RA medications also interrupt the process. Doctors detect anemia with another blood test.
The Physical Exam
During an RA appointment, expect a standard physical exam. The doctor may check your joints for signs of swelling, inflammation, and deformity. Remember when you experience symptoms, advises rheumatologist Dr. Howard Smith.
Dr. Smith also asks patients if they experience any other symptoms during their flare-ups. Finally, he encourages patients to ask questions and remain patient. You can express what you think is causing the symptoms, but the doctor may not agree. Listen to their professional opinions.
Go In With An Open Mind
Many patients research before they visit the doctor for a rheumatoid arthritis diagnosis or treatment. That's great, but you should head in with an open mind, says rheumatologist David Batt. The doctor will diagnose you entirely based on your medical history and symptoms.
In its early stages, rheumatoid arthritis can resemble Osteoarthritis, Lupus, Lyme arthritis, and Sjogren's syndrome, according to WebMD. Doctors may have you undergo an extensive diagnosis to rule out any of these other conditions.
Family History Matters
Family and medical history matter when discussing RA. According to the National Rheumatoid Arthritis Society, several studies prove that people are more likely to get RA if a family member has it. If your parent or sibling has RA, you're three times more likely to get it.
Although genetics influence your chance of getting rheumatoid arthritis, scientists still aren't sure how big of a role it plays. Hence, a doctor will ask about your medical history and family.
Come Prepared To Answer Questions
As with any medical appointment, your doctor may ask several questions. They will ask how often you experience symptoms and when they first started. They may request that you describe the pain--dull, throbbing, aching, burning, or another sensation.
Doctors may want to know what makes the pain worse and what makes it better. For instance, does it hurt more after exercise? Does sleeping make it more or less severe? Prepare for these questions before you go to your appointment.
Watch Out For Joint Pain And Tenderness
Joint pain and tenderness are common signs of RA. According to the Rheumatoid Arthritis Support Network, this pain can feel similar to an old sports injury. Over time, the inflammation can create redness that appears on the joints.
The pain gets better and worse based, on "flares." Researcher Clifton O. Bingham says that these flares come and go, even when the disease is controlled. If your joint pain lasts more than a couple of weeks, it could be chronic RA.
Checking For Swelling And Stiffness
When joints get inflamed, they can swell. After prolonged inflammation, the tissues inside joints retain fluids in a process called edema. Your joints can become red and tender to the touch, says the Arthritis Foundation. And this painful swelling can make your joints stiff.
Joint stiffness comes and goes for RA patients. Many struggle to flex their joints in the morning, after exercise, or after sitting for a while. Your doctor may ask when the swelling and stiffness occur.
Which Joints Receive Symptoms?
Although rheumatoid arthritis can affect any joint, some are more commonly targeted than others. The hands, which contain 25 joints, frequently hurt with the condition. Usually, the knuckles, wrist, and thumb socket hurt the most.
Other frequently-affected areas include the feet, ankles, knees, and shoulders, says the Arthritis Foundation. Sometimes, patients will feel chest burning from the inflammation. Doctors may ask which areas of the body hurt and when, to confirm whether you have signs of RA.
The Risks Of RA
Over time, RA patients with weakened joints can become injured. According to Johns Hopkins Arthritis Center, 80% to 85% of RA patients suffer from joint damage within their first two years. The more this happens, the higher the risk of mortality.
People with rheumatoid arthritis have a mortality rate that's twice as high as healthy adults. If you believe that you may have RA, get your symptoms checked. Early diagnosis will significantly improve your treatment.
These Risk Factors Increase Your Odds Of RA
If you talk to a doctor about RA, they may ask for your age, living conditions, and habits. These are risk factors that could increase your chances of rheumatoid arthritis. For instance, most people get rheumatoid arthritis between the ages of 30 and 50, and it is twice as common in women.
The scientific journal Peer J lists several other risk factors. Substance abuse and obesity significantly increase the chances of diagnosis. Many RA patients also have diabetes, osteoporosis, and insufficient vitamin A in their diet.
Early Diagnosis Is Crucial
Although RA diagnosis seems long and tedious, you should start it as soon as possible if you have symptoms. "Early diagnosis leads to earlier treatment and obviously better outcomes," says assistant professor Hareth Madhoun.
Dr. Paul Emery, a rheumatoid arthritis researcher, emphasizes that early diagnosis improves your treatment options. The sooner you receive preventative therapy, the less pain you'll feel. Most likely, you'll have to try different medications to find one that works, and this takes time.
When Should You See A Doctor?
At what point should you suspect that you could have RA? As a general rule, see a professional if your pain lasts more than a week, says rheumatologist Dr. Alana B. Levine. If you can't discern a cause for your symptoms, visit a doctor.
Also, track the severity of your symptoms. If you have a joint pain spell that lasts more than three days, see a doctor. If the pain prevents you from doing daily activities, talk to a professional.
Details On RA Medication
Once you're diagnosed, what happens next? Often, doctors will prescribe medication. Dr. Judith Frank of Arthritis-Health lists five types of medicine: anti-inflammatories (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), steroids, biologics, and janus kinase (JAK) inhibitors.
Most patients are prescribed DMARDs at first, which suppress the immune system to reduce the arthritis symptoms. Others may be put on a steroid for a limited time. Since people respond differently to certain medications, it may take a while to find a long-term drug for the condition.
Changes In Your Fingernails
People with rheumatoid arthritis may begin to see changes in their fingernails. People with RA may see their nails yellow, thicken, or develop vertical ridges. These could be indicators of RA or another condition, so it's best to consult with your doctor.
Changes in nail color may be treated with medication. If you experience nail ridging, it's recommended to adopt a regular nail care routine at home, keeping nails clean and trimmed.
Natural Remedies Can Help, Too
Dr. Elizabeth Volkmann recommends trying natural remedies alongside medication. In some cases, these techniques can reduce the prescription needed, but don't try to invent your own cure. And never self-diagnose to try natural remedies.
However, no natural remedy works better than medication. "There are some alternative therapies that could be dangerous and worsen your symptoms," warns Dr. Batt. If you try natural remedies, always tell your doctor. And don't rely on them to "heal" rheumatoid arthritis.
Taking Care Of Yourself With Rheumatoid Arthritis
Because there is no surefire treatment for rheumatoid arthritis, patients need to care of themselves. Medications can assuage the symptoms, but RA is a chronic disease that needs to be handled on a case-by-case basis. Certain habits can help or worsen the condition.
Taking medications as directed and attending scheduled appointments are two ways to make rheumatoid arthritis more comfortable to live with. Coming up are more tips to help assuage an RA patient's symptoms over time.
A Mediterranean Diet Can Help
A healthy diet does wonders for rheumatoid arthritis, especially the newly-researched Mediterranean diet. In 2018, a study in Rheumatology International found that following the Mediterranean diet relieved pain and improved joint movement in participants. The results were short-term, but they were noticeable.
The Mediterranean diet cooks with olive oil, legumes, fish, lean meat, and plenty of produce. Dana DiRenzo, an instructor of medicine at Johns Hopkins University, also recommends staying away from processed foods with enriched flours.
Exercise Can Improve Joint Pain
Although it seems contradictory, exercise can relieve joint pain in RA patients. After analyzing 33 studies, researchers concluded that exercise improves the health of people with rheumatoid arthritis. Working out can also decrease the pain significantly, according to the study.
Low-intensity exercises such as yoga, walking, swimming, and strength training can suit people with RA. Some patients visit physical trainers to learn which exercises help their symptoms. It can also reduce inflammation, according to a controlled trial in 2019.
Hot And Cold Therapy
An ice pack can reduce inflammation; a heating pad can assuage pain and muscle spasms. Both of these options can alleviate symptoms in people with RA. Research in Expert Review of Clinical Immunology noted that cold therapy soothes joint pain. According to the American Journal of Nursing Research, heat therapy improves joint mobility, pain, and stiffness.
Try applying heat or cold packs in ten-minute intervals. Heat can improve mobility and pain, while cold lowers inflammation and the "burning" ache.
Get Enough Sleep
Poor sleep can make rheumatoid arthritis worse. According to the Journal of Clinical Medicine, poor sleep causes more pain and less flexibility in RA patients. During another study in the Journal of Clinical Sleep Medicine, insomnia worsened fatigue, pain, movement, and depressive symptoms in patients.
Why does sleep help so much? Because it produces chemicals that combat inflammation, says rheumatologist Rochelle Rosian. Even if you're not having a flare-up, a lack of sleep could make the pain worse.
Join A Support Group
RA patients have access to support groups that can make a significant difference in their lives. In 2015, a study on RA support groups found that members had better lives after attending. They learned more about the disease and handled their symptoms with confidence.
Online support groups can do the same. According to a 2020 study in Clinical Rheumatology, members of a Facebook support group experienced many of the same benefits. You may be surprised by what peer support accomplishes.
Reduce Stress
Scientists believe that stress could make rheumatoid arthritis worse. According to Arthritis Research & Therapy, stress enhances the pain. With more pain, there's more stress, creating a cycle that makes all the symptoms worse. During a 2017 study, stress caused relapses of pain in RA patients, even when the disease was well-managed.
The Arthritis Foundation recommends several techniques to alleviate stress. Taking time to relax and exercise can help, and if that doesn't work, patients can discuss with their physician.
RA Patients May Want To Take Probiotics
Some studies suggest that probiotics can improve inflammatory disorders like rheumatoid arthritis. According to a 2018 study in Nutrients, certain probiotics can soothe inflammation in the joints. Plus, some experts believe that issues in the microbiome may contribute to RA.
"Whenever there is a chronic disease that impacts the intestinal tract, including arthritis, there is the potential to treat it with probiotics," says assistant professor Dr. Jeremy P. Burton. Patients with RA may want to give probiotics a try.
Take Omega-3 Fatty Acids
Research suggests that omega-3 fatty acids can soothe RA symptoms. During a 2016 study, participants were able to reduce their medication after taking omega-3's. Although this may not work for everyone, eating more fatty acids can still improve disease symptoms.
After analyzing 13 studies, researchers concluded that omega-3's might reduce joint pain in RA symptoms. The fatty acids activate compounds that assuage inflammation in the body. You can get these nutrients from fatty fish or supplements.
Get Massages
As with any muscle or joint pain, a massage can do wonders. During a 2013 study, participants received a light or medium-pressure massage once a week. After a month, their RA pain lessened, and they had better flexibility in their wrists and elbows.
Earlier research in Complementary Therapy in Clinical Practice combined a weekly professional massage with daily self-massages. RA patients who did this had better pain relief, a happier mood, and deeper sleep. And you don't have to spend money on self-massage.
Mindfulness And Meditation
Practicing mindfulness and meditation has many benefits for RA patients. According to the Journal of Orthopedics and Rheumatology, daily meditation can improve peoples' moods by 35%. It also helps RA patients cope better with their symptoms.
In 2020, a scientific review concluded that meditation improved pain intensity, depression, and other symptoms of the disease. Although it doesn't directly impact RA, mindfulness meditation may improve patients' quality of life. In turn, it can help them tackle their symptoms.
