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Stiffness: Patients may note being particularly stiff in the morning, and may also note pain on movement and tenderness.
Palindromic joint swelling: Patients often report swelling in one or two joints that lasts a few days to weeks; it may disappear completely, only to return later in the same or other joints, with a pattern increasing over time.
Polyarticular joint involvement: Patients may report symptoms in five or more joints, though this is highly variable.
Non-specific systemic symptoms: Patients may experience primarily fatigue, malaise, or depression, and these symptoms frequently precede other symptoms by weeks to months.
One of the most important and helpful criteria in reaching a diagnosis is the blood test to identify a specific set of antibodies that are known biomarkers for assessing rheumatoid arthritis. There isn’t one single test that can produce a diagnosis, but there are multiple blood tests that can be performed in the diagnostic process.
International guidelines classification criteria recommend laboratory testing for:6
Numerous international guidelines recommend RF IgM and anti-CCP as first line tests. CCP antibodies appear in the early stages of rheumatoid disease, and RF IgM is the major RF autoantibody in RA and are detected in 60 percent to 80 percent of RA patients.7,8
RF has proven to be the most useful disease marker of RA,9 and the association between high titer RF IgM status and a poor prognosis indicates that RF may have a role in the pathogenesis of RA.
As active disease approaches, RF IgM and CCP levels surpass RF IgA levels.
A clinical history and examination are chief to identifying RA, with imaging and laboratory tests providing additional specificity that can help you diagnose patients and begin treatment earlier.10,11
Many tests measure rheumatoid factor (RF) using nephelometry or turbidometry. However, using an RA panel that can distinguish between the different RF isotypes—RF IgA and RF IgM in particular—can give you important additional diagnostic guidance.12-14
Testing can help provide a quicker diagnosis, while potentially ruling out other possible diseases, and is simple, specific, and reliable.
The 2010 American College of Rheumatology/European League Against Rheumatism collaborative initiative classification criteria are based on clinical presentation of synovitis (joint swelling), serology, acute-phase reactants, and duration of symptoms. Once other conditions have been ruled out, a patient is classified as having RA if a score of ≥ 6 out of a possible 10 is reached.15
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
Early treatment is imperative for rheumatoid arthritis (RA), as joint destruction begins within a few weeks of symptom onset.16 Therapeutic goals include function and quality of life preservation, pain and inflammation minimization, joint protection, and complication control.16 The goals of RA management are to:17
Across the American College of Rheumatology guidelines, the ACR Subcommittee on Rheumatoid Arthritis recommends that patients with suspected RA be referred to a rheumatologist within three months of presentation for diagnosis and initiation of treatment with disease modifying antirheumatic drugs (DMARDs).16
Pharmacologic therapy for RA often consists of combinations of NSAIDs, DMARDs, and/or glucocorticoids.16,17
NOTE: 2019 American College of Rheumatology Guideline for the Management of Rheumatoid Arthritis (final publication of updated guideline anticipated in late 2019/early 2020)