- 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The seven diagnostic criteria have been replaced by the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for RA, which rates the signs and symptoms of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.
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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
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