Rheumatoid arthritis - diagnosis and treatment (2023)


Rheumatoid arthritis can be difficult to diagnose in the early stages because the early signs and symptoms are similar to those of many other diseases. There is no single blood test or physical finding to confirm a diagnosis.

During the physical exam, the doctor will check for swelling, redness, and warmth in the joints. He or she may also check your reflexes and muscle strength.

Blood test

People with rheumatoid arthritis often have elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) levels, which can indicate the presence of an inflammatory process in the body. Other common blood tests look for antibodies against rheumatoid factor and cyclic citrullinated peptide (anti-CCP).

imaging tests

Your doctor may recommend x-rays to help monitor the progression of rheumatoid arthritis in your joints over time.magnetic resonanceand ultrasound tests can help your doctor assess the severity of disease in your body.

More information

  • C-reactive protein test
  • magnetic resonance
  • factor reumatoide
  • Sed rate (erythrocyte sedimentation rate)
  • Ultrasound
  • X-rays


There is no cure for rheumatoid arthritis. But clinical studies show that remission of symptoms is more likely if treatment with drugs known as disease-modifying antirheumatic drugs (DMARDs) is started early.


The types of medicines your doctor recommends will depend on the severity of your symptoms and how long you have had rheumatoid arthritis.

(Video) Rheumatoid arthritis - causes, symptoms, diagnosis, treatment, pathology

  • AINE.Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. On the counterAINEthey include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). StrongerAINEThey are available by prescription. Side effects can include stomach irritation, heart problems, and kidney damage.
  • steroidsCorticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects can include bone thinning, weight gain, and diabetes. Doctors often prescribe corticosteroids for rapid symptom relief, with the goal of gradually reducing medication intake.
  • ConventionalDMARD.These drugs can slow the progression of rheumatoid arthritis and save joints and other tissues from permanent damage. UsualDMARDthey include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine). Side effects vary, but can include liver damage and serious lung infections.
  • Biological agents.Also known as biologic response modifiers, this new classDMARDThese include abatacept (Orencia), adalimumab (Humira), anakinru (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara) and tocilizumab (Actemra). ). . . . .

    BiologicalDMARDthey are generally more effective in combination with conventional onesFARMSsuch as methotrexate. This type of medication also increases the risk of infections.

  • Targeted SyntheticsDMARD.Baricitinib (Olumiant), tofacitinib (Xeljanz) and upadacitinib (Rinvoq) can be used if they are conventional.DMARDand biologics were not effective. Higher doses of tofacitinib may increase the risk of blood clots in the lungs, serious heart-related events, and cancer.


Your doctor may refer you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks that will be easier on your joints. For example, he may want to lift an object with his forearms.

Assistive devices can make it easier to avoid stress on painful joints. For example, a kitchen knife equipped with a handle helps protect fingers and joints. Certain tools, such as pins, can make dressing easier. Catalogs and medical supply stores are good places to look for ideas.


If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair the damaged joints. Surgery can help you regain the ability to use the joint. It can also reduce pain and improve function.

Rheumatoid arthritis surgery may include one or more of the following procedures:

  • Synovectomy.Surgery to remove the inflamed joint lining (synovium) can help reduce pain and improve joint flexibility.
  • Tendon repair.Inflammation and damage to the joint can cause the tendons around the joint to become loose or tear. Your surgeon may be able to repair the tendons around your wrist.
  • Joint merger.Surgical fusion may be recommended to stabilize or realign the joint and to relieve pain when joint replacement is not an option.
  • Total joint replacement.During joint replacement surgery, your surgeon removes the damaged parts of the joint and inserts a prosthesis made of metal and plastic.

Surgery carries the risk of bleeding, infection, and pain. Discuss the benefits and risks with your doctor.

More information

  • elbow replacement surgery
  • Hip replacement
  • knee replacement
  • shoulder replacement surgery
  • spinal fusion
(Video) How is Rheumatoid Arthritis Diagnosed? | Johns Hopkins Rheumatology

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(Video) Rheumatoid Arthritis - Diagnosis | Johns Hopkins

clinical trials

Explore Mayo Clinic studiesTry new treatments, interventions, and tests as ways to prevent, detect, treat, or manage this condition.

Lifestyle and home remedies.

You can take steps to care for your body if you have rheumatoid arthritis. These self-care measures, when used along with rheumatoid arthritis medications, can help you manage your signs and symptoms:

(Video) Rheumatoid Arthritis - Signs & Symptoms | Johns Hopkins Medicine

  • Exercise regularly.Light exercise can strengthen the muscles around your joints and reduce any fatigue you may feel. Consult your doctor before beginning to exercise. If you're just starting out, start by walking. Avoid exercising tender, injured or severely inflamed joints.
  • Apply heat or cold.Heat can relieve pain and relax tense and sore muscles. Cold can dull the sensation of pain. Cold also has a numbing effect and can reduce swelling.
  • Chill out.Find ways to cope with pain by reducing the stress in your life. Techniques such as guided imagery, deep breathing, and muscle relaxation can be used to manage pain.

More information

  • 6 tips to control the symptoms of rheumatoid arthritis
  • Rheumatoid arthritis and exercise.
  • Does stress make rheumatoid arthritis worse?
  • How can I reduce fatigue from rheumatoid arthritis?

alternative medicine

Some common complementary and alternative treatments that have shown promise for rheumatoid arthritis include:

  • Fish oil.Some preliminary studies have found that fish oil supplements may reduce pain and stiffness in rheumatoid arthritis. Side effects can include nausea, belching, and a fishy taste in the mouth. Fish oil can interfere with medications, so check with your doctor first.
  • Vegetable oils.Evening primrose, borage, and black currant seeds contain a type of fatty acid that can help with rheumatoid arthritis and morning stiffness. Side effects can include headache, diarrhea, and gas. Some herbal oils can cause liver damage or interfere with medications, so check with your doctor first.
  • Tai Chi.This movement therapy includes gentle exercises and stretching combined with deep breathing. Many people use tai chi to relieve stress in their lives. Small studies have found that tai chi can improve mood and quality of life in people with rheumatoid arthritis. When led by an experienced instructor, tai chi is safe. But do not make movements that cause pain.

coping and support

The pain and disability associated with rheumatoid arthritis can affect a person's work and home life. Depression and anxiety are common, as are feelings of helplessness and low self-esteem.

The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Talk to your doctor or nurse about coping strategies. Over time, you will learn which strategies work best for you. Meanwhile, try:

  • Take the control.Make an arthritis management plan with your doctor. This will help you feel responsible for your illness.
  • Know your limits.Rest when you are tired. Rheumatoid arthritis can make you prone to fatigue and muscle weakness. Rest or a short nap that does not disturb your night's sleep may help.
  • Connect with others.Let your family know how you feel. They may be concerned about you, but not comfortable asking about your pain. Find a family member or friend to talk to when you feel particularly overwhelmed. Also connect with other people who have rheumatoid arthritis, either through a support group in your community or online.
  • Take time for yourself.It's easy to be busy and not have time for yourself. Take time for what you love, whether it's journaling, going for a walk, or listening to music. This can help reduce stress.

Preparing for your date

Although you may first discuss your symptoms with your family doctor, he or she may refer you to a doctor who specializes in treating arthritis and other inflammatory conditions (a rheumatologist) for further evaluation.

What can you do

Write a list that includes:

  • Detailed descriptions of your symptoms.
  • Information about health problems you have had in the past
  • Information about the health problems of your parents or siblings
  • Any medications and supplements you are currently taking or have taken in the past for this problem
  • Questions you want to ask your doctor

What you can expect from your doctor

Your doctor may ask you some of the following questions:

(Video) Rheumatoid Arthritis Symptoms and Treatment - Dr. Sadia Khan - Mercy

  • When did your symptoms start?
  • Have your symptoms changed over time?
  • What joints are affected?
  • Do any activities make your symptoms better or worse?
  • Do the symptoms interfere with your daily tasks?

Mayo Clinic Staff

January 25, 2023


What is the best way to diagnose rheumatoid arthritis? ›

Imaging Tests

Magnetic resonance imaging (MRI) and ultrasound may help diagnose rheumatoid arthritis in the early stages of the disease. In addition, these imaging tests can help evaluate the amount of damage in the joints and the severity of the disease.

What is the first treatment for rheumatoid arthritis? ›

The first-line treatment for RA is usually a DMARD called methotrexate (Rheumatrex, Trexall). You may also get steroids or corticosteroids as an anti-inflammatory. That's enough for most people, though some may need to increase the dose.

What are the 7 diagnostic criteria for RA? ›

Classification criteria
  • Morning stiffness. Morning stiffness in and around the joints, lasting at least 1 hour.
  • Arthritis of ≥3 joints. The qualified areas are PIP, MCP, wrist, elbow, knee, ankle, and MTP joints.
  • Arthritis of hand joints. ...
  • Symmetric arthritis. ...
  • Rheumatoid nodules. ...
  • Rheumatoid factor. ...
  • Radiographic changes.

What is the most successful treatment for rheumatoid arthritis? ›

1. NSAIDs. Most people with RA are advised to take a non-steroidal anti-inflammatory drug to decrease pain and inflammation. NSAIDs are sold over-the-counter, under such names as Advil and Aleve, as well as by prescription, under names such as Mobic and Celebrex.

What can be mistaken for rheumatoid arthritis? ›

Conditions That Can Look Like RA
  • Lyme Disease.
  • Psoriatic Arthritis.
  • Sjögren's Syndrome.
  • Gout.
  • Fibromyalgia.
  • Lupus.
Sep 4, 2022

How do I know if my arthritis is rheumatoid? ›

Signs and symptoms of rheumatoid arthritis may include: Tender, warm, swollen joints. Joint stiffness that is usually worse in the mornings and after inactivity. Fatigue, fever and loss of appetite.

What is Stage 1 rheumatoid arthritis? ›

Stage I: Synovitis

During stage I, you may start having mild symptoms, including joint pain and joint stiffness. Most commonly, this affects the hands and fingers, as well as the ankles and knees. The immune system has begun attacking the joint tissue, causing the synovial membrane to swell and become inflamed.

What foods should be avoided with rheumatoid arthritis? ›

6 Foods to Avoid When You Have Rheumatoid Arthritis
  • Red Meat. Many cuts of red meat contain high levels of saturated fat, which can exacerbate inflammation and also contribute to obesity. ...
  • Sugar and Refined Flour. ...
  • Fried Foods. ...
  • Gluten. ...
  • Alcohol. ...
  • Processed Foods.
Feb 27, 2021

How quickly does rheumatoid arthritis spread? ›

The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days. The symptoms vary from person to person. They may come and go, or change over time. You may experience flares when your condition deteriorates and your symptoms become worse.

Can a blood test detect rheumatoid arthritis? ›

No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition. Some of the main blood tests used include: erythrocyte sedimentation rate (ESR) – which can help assess levels of inflammation in the body.

What is the root cause of rheumatoid arthritis? ›

Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue. However, it's not yet known what triggers this. Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.

What does RA pain feel like? ›

A person with RA may feel intense pain in their joints during flares. This can feel like sustained pressure, a burning sensation, or a sharp pain. However, people with RA may also experience periods of remission when they feel few to no symptoms. In addition to causing joint pain, RA can affect the whole body.

Does vitamin D help arthritis? ›

Dr Sarah Schenker, a dietitian and author of the British Dietetic Association's food fact-sheet on arthritis, says: “Vitamin D seems to have a role in reducing inflammation and keeping the immune system healthy, making it an important nutrient for different types of arthritis.”

What is the life expectancy of rheumatoid arthritis with treatment? ›

In the study, the median survival rate for healthy adults was approximately 82 years while the median survival rate for people with RA was approximately 77 years.

Is RA considered a disability? ›

Is Arthritis a Disability? Simply being diagnosed with rheumatoid arthritis does not qualify you for disability. However, if your ability to work is greatly affected or impaired by your condition, then with the proper documentation, you may be entitled to SSA disability benefits.

What acts like rheumatoid arthritis but isn t? ›

Lupus and Scleroderma

The autoimmune diseases systemic lupus erythematosus and scleroderma are two separate conditions but often present with joint involvement that mimics rheumatoid arthritis.

Does rheumatoid arthritis show up on xrays? ›

For decades, X-rays were used to help detect rheumatoid arthritis (RA) and monitor for worsening bone damage. In the early stages of RA, however, X-rays may appear normal although the disease is active, making the films useful as a baseline but not much help in getting a timely diagnosis and treatment.

How do doctors tell the difference between arthritis and rheumatoid arthritis? ›

The main difference between osteoarthritis and rheumatoid arthritis is the cause behind the joint symptoms.
Topic Overview.
CharacteristicRheumatoid arthritisOsteoarthritis
Joint symptomsJoints are painful, swollen, and stiff.Joints ache and may be tender but have little or no swelling.
5 more rows

What is the most common drug used for rheumatoid arthritis? ›

Methotrexate is usually the first medicine given for rheumatoid arthritis, often with another DMARD and a short course of steroids (corticosteroids) to relieve any pain. These may be combined with biological treatments.
The DMARDs that may be used include:
  • methotrexate.
  • leflunomide.
  • hydroxychloroquine.
  • sulfasalazine.

Where does rheumatoid arthritis usually hurt? ›

RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue.

What is the most painful type of arthritis? ›

Rheumatoid arthritis can be one of the most painful types of arthritis; it affects joints as well as other surrounding tissues, including organs. This inflammatory, autoimmune disease attacks healthy cells by mistake, causing painful swelling in the joints, like hands, wrists and knees.

What happens if rheumatoid arthritis goes untreated? ›

Without appropriate treatment, chronic pain, disability, and excess mortality are unfortunate outcomes of this disease. RA causes joint damage in 80% to 85% of patients, with the brunt of the damage occurring during the first 2 years of the disease. Left untreated, the risk of mortality is increased.

What is the average age of rheumatoid arthritis? ›

Average Onset

Most people have symptoms of RA between ages 30 and 60, but men are unlikely to be diagnosed under age 45. 2 Across both men and women, the median age of onset is 58. RA can be categorized as young-onset rheumatoid arthritis (YORA) and later-onset rheumatoid arthritis (LORA).

What does early RA look like in hands? ›

Some people with RA will develop hard lumps under the skin called nodules, often around pressure points. In the hands, nodules may appear on finger joints and wrists.

Is coffee bad for rheumatoid arthritis? ›

One additional cup of coffee consumed per day was associated with an increased risk of RA by 6% (95% CI: 1.02–1.10; I2 = 0%). This increase in the risk of RA for one cup/d of decaffeinated coffee was 11% (95% CI: 1.05–1.18; I2 = 38).

What is the best exercise for rheumatoid arthritis? ›

Studies indicate that exercise will not worsen rheumatoid arthritis symptoms. But if rheumatoid arthritis has severely damaged your hips or knees, you may want to choose low-impact exercises, such as swimming, water aerobics, walking or bicycling.

What vitamins is good for arthritis? ›

Here are 9 vitamins and supplements, backed by science, that help relieve arthritis pain.
  • 9 Supplements for Arthritis. ...
  • SAM-e or S-adenosylmethionine. ...
  • Boswellia Serrate or Indian frankincense. ...
  • Capsaicin or Capsicum frutescens. ...
  • Turmeric/Curcumin or Curcuma longa. ...
  • Avocado-soybean Unsaponifiables or ASU.

What is the best position to sleep in with rheumatoid arthritis? ›

Side sleepers should lie on the side that is not painful and place a thick pillow under the arm of the painful shoulder to keep it elevated. Shift the shoulder back instead of letting it slump forward if possible. When back sleeping, place a pillow under each arm. This can also be helpful for elbow pain, says Picard.

Can RA turn into lupus? ›

Rhupus syndrome patients often start with RA and develop signs of lupus about four to seven years later. The most common symptoms of rhupus sydrome are: Being sensitive to light (also called photosensitivity) Butterfly rash.

Do you sleep a lot with rheumatoid arthritis? ›

People with rheumatoid arthritis typically have several permanently inflamed joints. The inflammation inside the body can lead to general physical weakness, drowsiness and exhaustion. This feeling of extreme tiredness is also called "fatigue." Some people find this to be the worst symptom of the disease.

Can MS be mistaken for rheumatoid arthritis? ›

MS and RA share some symptoms, including numbing and tingling, muscle weakness, chronic fatigue, and problems with mobility, and eye inflammation, which can lead to eye pain and vision problems.

What is the safest drug for rheumatoid arthritis? ›

Rheumatoid Arthritis Drugs With The Least Side Effects

The RA drug with the least side effects is hydroxychloroquine (Plaquenil).

What symptoms does a rheumatologist look for? ›

When should you see a rheumatologist?
  • Pain, stiffness or swelling in more than one joint.
  • Fatigue.
  • Generalized weakness.
  • Skin rashes or lesions.
  • Hair loss.
Apr 4, 2022

What viruses trigger rheumatoid arthritis? ›

Many viruses could be responsible for causing viral arthritis, the most common being Parvovirus, alphavirus, rubella, Hepatitis B, C, and flavivirus. Some other viruses can also cause arthritis/arthralgia rarely. These are EBV, HIV, mumps, herpes, and cytomegalovirus (CMV).

What viruses can trigger RA? ›

The Epstein-Barr virus isn't the only virus suspected as an infectious agent in RA. Other examples include retroviruses and parvovirus B19, which causes fifth disease.

Can stress cause rheumatoid arthritis? ›

One of the biggest contributors to rheumatoid arthritis is stress, so keeping stress levels under control is key for anyone who struggles with this autoimmune condition. Older adults with rheumatoid arthritis may experiences new stressors that cause flare-ups. Symptom management is especially important for seniors.

Is B12 good for rheumatoid arthritis? ›

There is some evidence that one version of vitamin B12, called methyl B12 or methylcobalamin, can help reduce pain caused by RA. Researchers believe that this pain reduction occurs because that form of vitamin B12 strengthens nerve fibers, which are then not as susceptible to irritation by inflamed joints.

What vitamin is best for rheumatoid arthritis? ›

For people with RA, vitamin D can have additional benefits. RA is an autoimmune disease, and vitamin D plays a role in the immune system. People with RA also have high levels of inflammation, and vitamin D helps decrease that.

Is WD 40 used for arthritis? ›

WD-40 Does Not Help Arthritis

Due to the myth that WD-40 helps arthritis, the WD-40 company website includes the following statement regarding the myth (amongst other cool myths, legends and facts)… Fact: This popular headline, appearing at least once a year in the tabloids, is completely FALSE.

What is the new pill for rheumatoid arthritis? ›

The newest drugs for the treatment of rheumatoid arthritis are the Janus kinase (JAK) inhibitors, which are FDA approved under the brand names Rinvoq, Olumiant, and Xeljanz.

What is the most common cause of death in patients with rheumatoid arthritis? ›

Heart disease should be considered a serious cause for concern among people with RA, even those who've yet to reach middle age.

What is everyday life like with rheumatoid arthritis? ›

How can rheumatoid arthritis change your everyday life? It's common to have stiff and painful joints in the morning, making it difficult to get up and start the day. Everyday chores like cooking, laundry, cleaning, garden work and recreational activities can become a challenge as the disease progresses.

Is fibromyalgia and rheumatoid arthritis related? ›

Fibromyalgia and rheumatoid arthritis can cause similar symptoms, such as pain and exhaustion. The symptoms may be difficult to distinguish if a person has both conditions. While fibromyalgia and rheumatoid arthritis (RA) share symptoms, they are unrelated.

Is rheumatoid arthritis a big deal? ›

Rheumatoid arthritis (RA) is a long-term (chronic) disease that causes inflammation of the joints. The inflammation can be so severe that it affects how the joints and other parts of the body look and function. In the hand, RA may cause deformities in the joints of the fingers. This makes moving your hands difficult.

What is the single most accurate test for rheumatoid arthritis? ›

CCP antibodies test

Between 60 and 80 percent of people with rheumatoid arthritis have CCP antibodies in their blood. An anti-CCP antibody test — also called an ACCP test or CCP-test — looks for the presence of these antibodies to help confirm rheumatoid arthritis.

What is the most diagnostic antibody for rheumatoid arthritis? ›

Rheumatoid factor

Despite its relatively low specificity, the presence of RF is widely used as a diagnostic marker for RA. RFs are antibodies directed to the crystallizable fragment of IgG molecules.

What are the five signs of rheumatoid arthritis? ›

What are the signs and symptoms of RA?
  • Pain or aching in more than one joint.
  • Stiffness in more than one joint.
  • Tenderness and swelling in more than one joint.
  • The same symptoms on both sides of the body (such as in both hands or both knees)
  • Weight loss.
  • Fever.
  • Fatigue or tiredness.
  • Weakness.

What is the newest test for rheumatoid arthritis? ›

Monitoring disease activity with Vectra by Labcorp

Vectra by Labcorp is an advanced blood test that objectively measures inflammation caused by rheumatoid arthritis.

Is rheumatoid arthritis considered a disability? ›

Is Arthritis a Disability? Simply being diagnosed with rheumatoid arthritis does not qualify you for disability. However, if your ability to work is greatly affected or impaired by your condition, then with the proper documentation, you may be entitled to SSA disability benefits.

What is the gold standard test for rheumatoid arthritis? ›

The ACR/EULAR Classification is now the gold standard for diagnosing rheumatoid arthritis.

Will rheumatoid arthritis show up in blood work? ›

No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition. Some of the main blood tests used include: erythrocyte sedimentation rate (ESR) – which can help assess levels of inflammation in the body.

What is the best marker for rheumatoid arthritis? ›

Blood tests

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body.

How do doctors confirm if you have arthritis? ›

Doctors usually diagnose arthritis using the patient's medical history, physical examination, X-rays, and blood tests. It is possible to have more than one form of arthritis at the same time. There are many forms of arthritis, and diagnosing the specific type you have can help your doctor determine the best treatment.

How did you first know you had rheumatoid arthritis? ›

The typical case of rheumatoid arthritis begins insidiously, with the slow development of signs and symptoms over weeks to months. Often the patient first notices stiffness in one or more joints, usually accompanied by pain on movement and by tenderness in the joint.

What is the first line for early stage rheumatoid arthritis? ›

Methotrexate. Methotrexate is now considered the first-line DMARD agent for most patients with RA.

What could trigger rheumatoid arthritis? ›

Overexertion, poor sleep, stress or an infection like the flu can all set off RA symptoms. With a predictable flare you'll temporarily feel worse, but your symptoms will resolve in time. Unpredictable flares have more uncertainty associated with them.


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