Diagnosing RA is challenging even during its early stages due to the variety of symptoms; many appearing similar to other arthritic disorders characterized with intense pain. A rheumatologist, specializing in diseases of connective tissue and joints typically is the one to diagnose and prescribe long-term management approaches.30 A physical examination, discussion of symptoms, x-rays (Figure 6) and a blood test comprise an essential diagnostic work-up.29 X-rays may not clearly identify bone changes in early stages; whereas ultrasound and magnetic resonance imaging (MRI) provides greater sensitivity in detecting early joint damage and erosions.35 Immunological testing determines the presence of a specific antibody, rheumatoid factor (RF), identified in approximately 80% suffering with RA after one year.36 Not all individuals present with an indicator of disease. Some with the RF may never be diagnosed with RA and others with RA may never exhibit the RF.29

Figure 6. X-ray of patient with Rheumatoid Arthritis.

RA is a disabling disease with most daily activities impaired. At least 50% of those diagnosed ten years from onset are unable to maintain full time employment. Those diagnosed before age 45 encounter greater disabilities than those diagnosed at 70+.30 The American College of Rheumatology (ACR) collectively defines the following as criteria used in classifying RA and states a minimum of four are necessary to be met for classification. They are as follows:

  1. Arthritis along with soft-tissue swelling in >3 of 14 joints/or groups of joints for a minimal duration of six weeks.
  2. Arthritis in hand joints for a minimal duration of 6 weeks.
  3. Specific places with subcutaneous nodules.
  4. Morning stiffness of six weeks and > one hour on most mornings.
  5. Six week duration of symmetrical arthritis.
  6. Joint erosion identified radiographically.
  7. RH factor level > 95%.

According to the ACR, criteria were designed to categorize research and further establish epidemiological associations for those with RA.37