Symptoms and Steps before the Final Diagnosis

Is this rheumatoid arthritis?

Rheumatoid arthritis usually presents with pain and inflammation in the hands, either in one or more fingers or in the wrists. Other diseases may affect the hands also, like osteoarthritis, or even gout or minor problems with hand tendons (tendinitis). What would make you think you have rheumatoid arthritis? Here are some clues:

  • Usually the pain is accompanied by a great difficulty to bend the fingers in the morning. Fingers are swollen and stiff.
  • Even if not at the same time, other joints might be also painful and stiff.
  • It lasts more than a few days.

In any case, if you have pain in your hands or other joints that lasts for more than a few weeks, it may be worth a visit to your GP. You may have osteoarthritis, and your GP should be able to deal with it, but if you have any type of arthritis you will need a referral to a rheumatologist as soon as possible.


What other symptoms may I have?

Inflammation can appear almost in any joint, although hands are the most typical. Feet can also be affected. It feels like needles in the sole of your feet. Knees, elbows, and shoulders may also hurt and feel stiff in the morning. In people of older age rheumatoid arthritis may start in shoulders and hips, making the raising from a chair, or getting in and out from a car, very difficult and painful.

Other parts of your body may experience inflammation, like your eyes (red eye), or lung (you may feel short of breath).

Inflammation makes you feel fatigued, and you may even have a low grade fever.


What should I do?

The first step if you recognize any of the symptoms above is to get an appointment with your GP and keep track of your symptoms so that you will be able to give a detailed report. If he or she suspects you may have rheumatoid arthritis, you should be preferably referred to a rheumatologist.

Good communication is the key for an early diagnosis and effective care. Later on (Establish a Good Partnership with your Therapists) we will give you some clues on how to prepare your first appointment with the rheumatologist.


What tests will give me a diagnosis?

The most important evidences to diagnose a person with rheumatoid arthritis are:

  • where it appears (mainly in the hands, symmetrical, in many joints)
  • how long it lasts (more than 3 weeks)
  • the results of some laboratory tests that will only need to draw some blood

Your rheumatologist will examine you, touching every joint searching for inflammation and tenderness. With this exam he or she will have an idea of the extension of your disease. Sometimes the rheumatologist writes down numbers after counting joints, and will ask you for your opinion on how active your disease is from 0 to 10. A final number, called DAS28 or SDAI or CDAI will be very helpful to follow you up.

Additionally, he or she may as well examine other parts of your body, such as your eyes or mouth, your heart and lungs, or the skin, as many rheumatic diseases may affect other parts of your body, and also other diseases may include arthritis. Your doctor will order lab tests, if your GP has not already provided them. Lab tests include erythrocyte sedimentation rate and C-reactive protein. These tests show elevated values in many other situations, especially during infections, and also in persons with cancer. They reflect the large amount of inflammation occurring in your body. Other tests are rheumatoid factor and anti-CCP antibodies. These later are usually ordered by the rheumatologists, but they may be available at the GP’s office. When these tests are positive, the prognosis is a little worse than if they are negative. In any case, treatment has to be started as soon as possible. Your doctor may order also X-rays of your hands and feet, to see whether you already have erosions (this is small holes in your bones around the joints), although they are not always needed for a diagnosis. With the clinical history (questions and exam) and the tests, the rheumatologist should be able to offer you a treatment already.


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