Diagnosing rheumatoid arthritis

Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation.

Seeing your GP

Your GP will carry out a physical examination, checking your joints for any swelling and to assess how easily they move. Your GP will also ask you about your symptoms.

It is important to tell your GP about all your symptoms, not just ones you think are important, as this will help the doctor make the correct diagnosis.

If your GP thinks you have rheumatoid arthritis, they will refer you to a specialist (rheumatologist).

After conducting a physical examination and consulting your medical history, your GP may carry out tests to help confirm the diagnosis, or they may refer you at the same time as requesting tests. Tests you may have are outlined below.

Blood tests

No blood test can definitively diagnose rheumatoid arthritis. While a number of tests can indicate you may have developed the condition, they will not necessarily prove or rule out the diagnosis. If you have persistent joint inflammation, you will need to see a rheumatologist.

Erythrocyte sedimentation rate (ESR)

In an ESR test, a sample of your red blood cells is placed into a test tube of liquid. The cells are then timed to see how fast they fall to the bottom of the tube (measured in millimetres per hour). If they are sinking faster than usual, you may have an inflammatory condition, such as rheumatoid arthritis.

C-reactive protein (CRP)

A CRP test can indicate if there is inflammation anywhere in the body by checking how much CRP is present in your blood. CRP is produced by the liver. If there is more CRP than usual, there is inflammation in your body.

Full blood count

The full blood count will measure your red cells to rule out anaemia. Anaemia is a condition where the blood is unable to carry enough oxygen, due to a lack of blood cells. Eight out of 10 people with rheumatoid arthritis have anaemia. However, anaemia can have many causes, including a lack of iron in your diet. Therefore, having anaemia does not prove that you have rheumatoid arthritis.

Rheumatoid factor

This blood test checks to see if a specific antibody, known as the rheumatoid factor, is present in your blood. This antibody is present in eight out of 10 people with rheumatoid arthritis. However, it cannot always be detected in the early stages of the condition. The antibody is also found in one in 20 people who do not have rheumatoid arthritis, so this test cannot confirm rheumatoid arthritis. If it is negative, another antibody test (for anti-CCP) may be done, which is more specific for the disease.

Joint imaging

X-rays of your joints can help differentiate between different types of arthritis. A series of X-rays can also help show how your condition is progressing. A chest X-ray may also be taken as both the disease and certain treatments (such as methotrexate) can affect the chest.

Musculoskeletal ultrasound may be used in the clinic to confirm the presence, distribution and severity of inflammation and joint damage.

Magnetic resonance imaging (MRI) scans can help show what damage has been done to a joint.

Want to know more?

• Arthritis Care: Getting a diagnosis
• National Rheumatoid Arthritis Society: How is it diagnosed?
• National Rheumatoid Arthritis Society: Explaining your symptoms (PDF, 808kb)