The seven diagnostic criteria for rheumatoid arthritis (RA), which were defined in the year 1987 and followed until 2010 in all clinical trials, include the following:
- Morning stiffness in and around joints lasting at least one hour before maximal improvement
- Soft tissue swelling of three or more joint areas observed by a physician
- Swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints
- Symmetric joint swelling
- Rheumatoid nodules
- The presence of rheumatoid factor in blood tests
- Radiographic erosions and periarticular osteopenia in hand or wrist joints or both
The first four criteria must have been present for at least six weeks.
The 1987 diagnostic criteria are not in use anymore because they cannot identify patients who may have initial stage RA. Late diagnosis of rheumatoid arthritis leads to delay in treatment and, subsequently, deterioration of the condition.
The seven diagnostic criteria have been replaced by the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for RA, which rates the signs and symptoms of the condition on a scoring system.
How is rheumatoid arthritis diagnosed?
Rheumatoid arthritis (RA) is a type of inflammatory arthritis that typically involves three or more joints. Early signs and symptoms are similar to many other diseases, such as psoriatic arthritis, gout, and systemic lupus erythematosus (SLE). Hence, it can be difficult to diagnose RA in its early stages.
Your doctor will first perform a careful physical examination and analyze your medical history. Confirming whether you have the condition or not requires a couple of tests, which includes:
- Positive rheumatoid factor (RF) or anti-cyclic citrullinated peptide antibody (anti-CCP) testing. RF test is positive in 70 to 80 percent of patients with RA.
- High levels of C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR).
Symptoms of RA should last for more than six weeks to be properly diagnosed with the condition.
Your doctor will also check if you have any signs and symptoms of other diseases, including psoriatic arthritis, acute viral polyarthritis, polyarticular gout or calcium pyrophosphate deposition disease, and SLE. Exclusion of these conditions helps the doctor to confirm your RA diagnosis.
Your doctor may recommend an X-ray to know how RA is affecting your joints in the long run. Magnetic resonance imaging (MRI) and ultrasound tests can help the doctor know the severity of the disease in your body.
Your doctor may diagnose you with seronegative RA if your blood reports are negative for both RF and ant-CCP tests, but you do not have any findings or signs and symptoms of other diseases.
Recent onset RA
If your symptoms suggest RA and are severe but have existed for less than six weeks, you may be diagnosed with the condition based on the findings that are otherwise characteristic of rheumatoid arthritis, including anti-CCP, and if the possibility of other diseases have been excluded.
How can I treat rheumatoid arthritis naturally?
While there is no cure for rheumatoid arthritis (RA), new drugs and treatments can help slow its progression and prevent it from worsening.
Learn about 17 natural remedies that can help relieve pain and stiffness and improve your quality of life.
17 ways to treat rheumatoid arthritis naturally
- Acupuncture: Acupuncture is a Chinese traditional therapy that requires a trained practitioner. There is no specific research regarding the effects of acupuncture on RA, but limited studies have reported that it reduces the number of chemicals that cause inflammation.
- Biofeedback therapy: Biofeedback therapy involves a technique to control automatic responses such as heart rate and blood pressure. Your therapist will teach you stress management techniques, which can help prevent attacks (flare-ups) of RA and ease your pain.
- Massage: Massage can help relieve pain. If you have had acute RA for a long time you may benefit from massage therapy from a trained massage therapist.
- Exercise: Regular exercise may help strengthen the muscles near the affected joints. A physical therapist can guide you to make sure you are following the right techniques.
- Heat: Heat helps relax your muscles and increase blood circulation. You can use a moist heating pad, warm damp towel, microwaveable hot pad, warm shower, or hot tub.
- Cold: Cold has a numbing effect that reduces pain and swelling. Use an ice pack for 15 minutes at a time and take a 30-minute break in between.
- Topical ointments: Most ointments are made from capsaicin which can be found in chili peppers. Application on affected joints may help reduce RA pain.
- Passive muscle relaxation: This involves contracting and relaxing all of your muscles—from your face to your feet. Inhale while contracting and exhale while relaxing.
- Tai chi: Tai chi is a slow and gentle type of martial art. While it’s unclear whether it helps relieve RA symptoms, it may help improve strength, flexibility, and balance.
- Turmeric: Also known as Curcuma, this herb blocks a protein that causes inflammation and helps reduce pain.
- Deep breathing: Taking deep breaths from your abdomen can help calm you and relax your muscles.
- Meditation: Focusing on your breathing can help you distract you from pain or other symptoms.
- Visualization techniques: This can help reduce stress and involves closing your eyes, taking a deep breath, and imagining yourself in a peaceful place.
- Yoga: Yoga is good for both body and mind and helps increase flexibility and reduce joint pain.
- Aromatherapy: While aromatherapy may not have a direct effect on inflammation and pain, it can help boost your mood.
- Fish oil: Some studies show that supplements containing fish oil reduce the stiffness and pain that come with RA. Fish oil may cause side effects and can interfere with other medicines, so consult your doctor before using it.
- Plant oil: Oils from some plant seeds such as evening primrose and black currant contain fatty acids that help reduce pain and stiffness caused by RA. These oils can cause side effects and may interfere with other medicines, so ask your doctor before using them.
It’s important to remember that these home remedies are not a replacement for traditional medical treatment, including medications.
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Venables PJW, Baker JF. Diagnosis and Differential Diagnosis of Rheumatoid Arthritis. UpToDate. https://www.uptodate.com/contents/diagnosis-and-differential-diagnosis-of-rheumatoid-arthritis
Rheumatoid Arthritis. https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis
Natural Remedies for Rheumatoid Arthritis Pain Relief. https://www.webmd.com/rheumatoid-arthritis/rheumatoid-arthritis-natural-treatments#
Rheumatoid arthritis. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
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