When getting a new diagnosis of Rheumatoid Arthritis, I find that most people need to start with the basics. It can be overwhelming. I know that not much beyond “You have Rheumatoid Arthritis” is heard and that everyone will need time to digest all the information out there.
So let’s talk about some Rheumatoid Arthritis facts and start with “What is Rheumatoid Arthritis?” RA is an autoimmune, systemic, inflammatory disorder. Seen in almost 1% of the US population, RA is more often seen in women compared to men and usually happens during middle age.
RA isn’t the only autoimmune systemic inflammatory disorder, but this is one way we differentiate it from osteoarthritis, which is simply a condition of degeneration of the joint. “Autoimmune” simply means the immune system has turned on itself and now is attacking your own body. “Systemic” means the entire “system” or body is affected and “inflammatory”, simply indicates that inflammation is what drives the symptoms and the potential joint damage.
More than just the joints
To call it “arthritis” really does everyone a disservice because it is so much more than just joint pain. RA patients can develop RA nodules, lung disease or even vasculitis (inflammation of the blood vessels). Thankfully in the current age of biologic therapy these complications are not as common, but the mere fact that they can happen highlights how RA can affect more than just the joints.
And we don’t want to forget the connection between RA and heart disease! Those with RA have higher rates of heart attacks and strokes, similar to what we see in diabetics. The reason for this is not completely understood, but it is theorized to be a result of the longstanding inflammation RA patients live with. This is an often under appreciated Rheumatoid Arthritis Fact.
How do you make a Rheumatoid Arthritis diagnosis?
The diagnosis of rheumatoid arthritis is based on multiple factors, including but definitely not limited to the rheumatoid factor blood test. So many of us get focused on the result of our blood tests but that is only one piece of the larger puzzle. One of the large puzzle pieces is your symptoms. This is why the conversation you have with your doctor is so important.
How long have you had your symptoms?
Where are your symptoms and does anything make them feel better or worse?
Is there a part of the day where your symptoms are worse?
The answers to these questions and others give your doctor important clues and helps them put your labs tests in context. Of course, after you spend time talking, your doctor will then do a physical exam. Your rheumatologist is going to examine you from head to toe, looking at every joint, even the ones that don’t hurt. They will also do a skin exam, look in your mouth and listen to your heart and lungs. You should expect a very thorough physical exam when you go in to check for rheumatoid arthritis.
And finally, we get to labs. Yes, labs such as the rheumatoid factor (RF) and the anti-CCP antibody are important. But we can’t forget about the basics. Your doctor is going to look at your kidney and liver function and check for anemia. All of these things get taken into account when we make a diagnosis for rheumatoid arthritis. A diagnosis of RA cannot be made simply from a blood test.
Do I need x-rays?
In some cases, especially where the symptoms aren’t entirely clear or your physical exam is not very striking, it may be necessary to go a step further and get x-rays, MRIs or ultrasounds of your joints. And X-ray can be very telling, especially in older individuals who also have osteoarthritis. Rheumatoid arthritis and osteoarthritis are not only different in who they affect and why they occur, but their appearance on X-ray also differs. Therefore, when the type of arthritis is unclear, an X-ray can be very helpful. This is also true for an MRI and an ultrasound. (Remember, an X-ray looks at the bones and an MRI and ultrasound can see bones AND the tendons, ligaments, joint fluid and muscles)
Stay turned for part 2 of this series!
In good health,
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