Diagnosing arthritis: What is the process?

Arthritis is an inflammation of the joints, which can manifest itself in about 100 different types of arthritis.

It can also affect the eyes, heart and skin. Treatments are available to allow people with arthritis to lead active and productive lives.

The most common symptoms of arthritis include pain, swelling, stiffness and a decreased range of motion of a joint or multiple joints. The symptoms can be mild, moderate or severe. Symptoms may come and go, be the same for many years then get worse quickly, or progressively get worse. In the more severe stages of arthritis, chronic pain will affect your ability to do activities of daily living. You may not be able to walk or climb stairs easily. Sometimes there are knobby-looking finger joints you can see, but most often arthritis is only visible on an X-ray. Arthritis, depending on the type, could affect the heart, lungs, kidneys, eyes and skin in addition to the joints.

The diagnostic process includes eliminating problems that cause symptoms similar to arthritis and assessing for over 100 types of arthritis. It is not easy to determine the specific type of arthritis because symptoms change or don’t show the full range of effects at once. One type of arthritis may be mistaken for another, or people may have multiple types at the same time.

If you have joint problems, seek help from your primary healthcare provider. Your provider will ask you questions about your medical and family history, health habits and symptoms. They’ll then do a physical exam and basic tests to check for the more common types of arthritis.

If your symptoms are more complex, you may require a more comprehensive assessment by a rheumatologist (a doctor who specializes in arthritis and rheumatic conditions) or an orthopedist (a doctor who specializes in treatment and surgeries for musculoskeletal conditions).

Other tests used to diagnose arthritis include a joint evaluation, lab tests and imaging tests, such as X-rays.

In a joint evaluation, your provider will look for:

• Signs of joint redness, swelling or stiffness
• Determine the types of joints affected
• Count the number of joints involved
• Assess if there is a symmetrical pattern on both sides of the body
• Check for fluid, warmth, joint movement or tenderness.

Your healthcare provider may order blood tests to check for inflammation, antibodies, liver and kidney function, and blood counts. There are specific antibodies that have been linked to one kind of arthritis, called rheumatoid arthritis (RA), caused by inflammation, which are measured by tests from blood samples. Rheumatoid factor (RF) has been found in up to 80% of people with RA, and antibodies to cyclic citrullinated peptide (CCP) have been found in 60% to 70% of people with RA. Your provider may also draw fluid from your joint with a needle, send it to a lab for analysis and run genetic testing.

Your provider may also recommend that you have imaging tests. For instance, X-rays are frequently ordered to visualize the joint. Other methods to assess joints include ultrasounds and magnetic resonance imaging (MRI). These tests can show if there are structural changes in the joint, erosions of the joint, loss of cartilage, tears in the soft tissue, fluid locations, inflammation and loose tissue fragments. Even though imaging tests help identify joint damage or bone loss, it doesn’t mean you do not have RA. It may mean RA is in early stages.

According to the  2010 American College of Rheumatology/European League against Rheumatism Classification Criteria for RA, individuals should be tested for the RA if they have :

• At least one joint with definite swelling
• Joint swelling that is not better explained by another disease

Individuals will be further evaluated on a point system for a definite diagnosis of RA based on:

• Degree of joint involvement
• Blood test that looks for inflammation and blood proteins (antibodies) that are linked to RA
• Symptom duration

Criteria may vary for other kinds of arthritis.

If you are experiencing symptoms of arthritis, see your healthcare provider. Early diagnosis and aggressive treatment can help prevent visible joint changes, chronic pain, loss of mobility and decreased function.

Clinically reviewed and updated by Nora Laberee, May 2022.