![When seeking a rheumatoid arthritis diagnosis, your doctor may order some blood tests, which can include rheumatoid factor (RF) assay, antinuclear antibody assay (ANA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, complete blood count, anti-cyclic citrullinated peptide (anti-CCP) and anti-mutated citrullinated vimentin assays, HLA tissue typing, Lyme disease, and uric acid.](https://images.medicinenet.com/images/mobile/hp_promo/rheumatoid-arthritis-treatment.jpg?output-quality=75)
Blood tests that are used to diagnose rheumatoid arthritis (RA), an autoimmune disease that primarily affects the body’s joints, include:
- Rheumatoid factor (RF) assay
- Antinuclear antibody assay (ANA)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP) level
- Complete blood count
- Anti−cyclic citrullinated peptide (anti-CCP) and anti−mutated citrullinated vimentin assays
- HLA tissue typing
- Lyme disease, to rule out Lyme as a cause for the symptoms
- Uric acid, to rule out gout
Along with blood tests, imaging studies may also be used to diagnose rheumatoid arthritis, such as:
- X-rays (first choice): Hands, wrists, knees, feet, elbows, shoulders, hips, cervical spine, and other joints as indicated
- Magnetic resonance imaging (MRI): Primarily cervical spine
- Ultrasound of joints: Joints, as well as tendon sheaths, changes and degree of vascularization of the synovial membrane, and even erosions
In some cases, joint aspiration and analysis of synovial fluid may be indicated.
What Are Symptoms of Rheumatoid Arthritis?
The first signs and symptoms of rheumatoid arthritis tend to come on gradually, often before joint pain or stiffness is noticeable, and may include:
- Muscle pain
- Numbness and tingling in the hands
- Fatigue
- Weight loss
- Low-grade fever
- Feeling unwell (malaise)
Joint pain and stiffness usually begin in small joints, such as the joints of the fingers or toes, or it may occur in a single, large joint, such as the shoulder or knee, or it may shift from one joint to another
Rheumatoid arthritis usually affects the same joints on both sides of the body (symmetrical). As the condition progresses, joint pain and inflammation become more prominent and symptoms include:
- Joint pain and stiffness that may affect the:
- Hands
- Finger deformities/bent fingers
- May result in carpal tunnel syndrome, which causes weakness, tingling, and numbness in the hand and fingers
- Wrist: difficulty bending the wrist backward
- Elbow: swelling may result in numbness or tingling in the fingers
- Shoulder: pain and limited motion
- Knee: difficulty bending the knee and development of a “Baker's cyst,” which is a fluid-filled cyst in the space at the back of the knee
- Ankle: nerve damage may occur, leading to numbness and tingling in the foot
- Foot: tenderness at the joints at the base of the toes may cause someone to stand and walk with weight on the heels. The top of the foot may be swollen and red, and the heel may be painful.
- Hips: difficulty walking
- Neck: painful and stiff, difficulty bending the neck and turning the head
- Cricoarytenoid joint: inflammation of a joint near the windpipe that can cause hoarseness and difficulty breathing
- Hands
- Other symptoms of rheumatoid arthritis may include:
- Bone loss/decreased bone density
- Muscle weakness
- Eye problems
- Redness
- Pain
- Vision problems
- Skin problems
- Rheumatoid nodules (painless lumps that appear beneath the skin)
- Lung disease
- Dry cough
- Shortness of breath
- Vasculitis: inflammation of the blood vessels
- Pericarditis: inflammation of the tissue around the heart that can cause chest pain and difficulty breathing
- Sjögren's syndrome
What Causes and Risk Factors of Rheumatoid Arthritis?
The cause of rheumatoid arthritis is unknown but it is thought that susceptibility factors and initiating factors may affect a person's risk of developing the condition:
Susceptibility factors increase a person’s susceptibility to developing rheumatoid arthritis when exposed to risk factors that initiate the inflammatory process. Susceptibility factors include:
- Being female: females are twice as likely as males to develop RA
- Age: middle-aged or older
- Genetics: people with a relative who has RA have an increased risk of developing the condition
Initiating factors (triggers) increase the chances a susceptible person will develop the disease, such as:
- Infection: bacteria in the gut or mouth and gums infection (periodontitis) in particular are risk factors
- Smoking
- Stress
What Is the Treatment for Rheumatoid Arthritis?
There are many different medications, therapies, and surgical treatments available to treat rheumatoid arthritis, which include:
- Nonbiologic disease-modifying antirheumatic drugs (DMARDS)
- Azathioprine (Imuran)
- Cyclosporine (Gengraf, Neoral)
- Gold salts
- Hydroxychloroquine (Plaquenil)
- Leflunomide (Arava)
- Methotrexate (Rheumatrex, Trexall, Otrexup)
- Minocycline (Dynacin, Minocin)
- Penicillamine (Cuprimine, Depen)
- Sulfasalazine (Azulfidine)
- Biologic tumor necrosis factor (TNF)–inhibiting DMARDs
- Adalimumab (Amjevita, Cyltezo, Humira, Hadlima, Hyrimoz, Adalimumab-atto, Adalimumab-adbm, Adalimumab-bwwd, Adalimumab-adaz)
- Certolizumab (Cimzia)
- Etanercept (Enbrel, Erelzi, etanercept-szzs)
- Golimumab (Simponi, Simponi Aria)
- Infliximab (Remicade, Inflectra, infliximab-dyyb, Renflexis, infliximab-abda, Ixifi, infliximab-qbtx)
- Biologic non-TNF DMARDs
- Abatacept (Orencia)
- Anakinra (Kineret)
- Baricitinib (Olumiant)
- Rituximab (Rituxan)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
- Tofacitinib (Xeljanz, Xeljanz XR)
- Upadacitinib (Rinvoq)
Other medicines used to treat rheumatoid arthritis include:
- Corticosteroids
- Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)
- Prednisolone (Orapred ODT, Pediapred)
- Prednisone (Prednisone Intensol, Rayos)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Pain relievers (analgesics)
- Topical skin products
- Diclofenac topical (Voltaren)
Surgical treatments for rheumatoid arthritis include:
- Synovectomy
- Tenosynovectomy
- Tendon realignment
- Reconstructive surgery or arthroplasty
- Arthrodesis
Other therapies for rheumatoid arthritis include:
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