Diagnosis and Treatment Of Rheumatoid Arthritis
If you suspect that you may have symptoms of rheumatoid arthritis, we explain what you can expect when you consult with your physician, and discuss available treatment options.
Painful, swollen joints could be a sign of rheumatoid arthritis, an autoimmune disease affecting approximately three times as many women as men. Early diagnosis is important to minimizing the effects of the disease. You can expect that your physician may use several tests to determine whether you have rheumatoid arthritis. Be prepared to describe your symptoms and explain the pain you feel. Your evaluation will probably include the following:
- A complete medical history. Be prepared to discuss any family history of arthritis, as well as your own symptoms. It will be very helpful if you can tell your doctor the times of day that you experience pain, and pinpoint when your pain seems to be most and least severe.
- A physical examination. During this exam, your physician will be looking for joint swelling, tenderness, redness and other signs of inflammation, joint misalignment, and any loss of motion you are experiencing.
- Laboratory tests. Your blood will be tested for the presence of an antibody called the rheumatoid factor. About 80 percent of people with rheumatoid arthritis have positive tests for this factor, though it isn’t always detected in the early stages of the disease. Other blood tests identify evidence of inflammation or anemia, which is often caused by rheumatoid arthritis.
- X-rays of symptomatic joints. X-rays are used to evaluate the degree of joint erosion and distortion, and measure cartilage loss.
If you are diagnosed with rheumatoid arthritis, you and your physicians will consider a number of treatments designed to address several aspects of the disease:
- Joint mobility. An appropriate exercise program is key to keeping joints flexible. You will also benefit by managing your weight, eating a healthy, nutritious diet, and maintaining a balance of rest and activity.
- Pain. In most cases, pain is treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen, naproxen, diclofenac, indomethacin, and COX-2 inhibitors. Your physician will take your heart health into account before considering treatment with COX-2 inhibitors, which carry an increased risk of heart attack and stroke.
- Inflammation. Corticosteroids may be used to reduce inflammation and control immune over-reactivity.
- Joint deterioration. Biologic agents are now available to slow joint destruction by inhibiting the cytokines that support inflammation and joint destruction.
- Surgery. If your joints are severely damaged, you and your physician may consider joint replacement surgery, which can dramatically improve pain and joint function.
Other treatments are being developed to offer additional therapy options to rheumatoid arthritis patients. Researchers hope to develop drugs that can block the processes that trigger arthritis. Remember that rheumatoid arthritis is an autoimmune disease: stem cell transplantation may someday be able to reconstitute a patient’s immune system, removing the triggers of the disease. Still other studies are evaluating markers that would enable us to diagnose rheumatoid arthritis before the disease process is underway. With early diagnosis, patients have multiple treatment options today, and can look forward to the introduction of additional promising treatments in the future.
Ask the Expert: Arthritis Video Series
Meet the Expert: Doctor Bio Video Series
Dr. Hansen explains why arthritis fellowship training is linked to better patient care and better outcomes.