Next, your Physical Therapist will do a physical examination of your joints. First, they will simply look and feel your joints for any signs of swelling which may include redness, increase in size, warmth, or possible abnormalities in the joint position, or abnormalities such as nodules. We will always compare both sides of your body for differences or similarities and will often check many joints even if they do not feel painful to you.
After that, your Physical Therapist will ask you to actively move your affected joints to assess your willingness and ability to move and also to determine if there is a range of motion deficit. Your Physical Therapist may also ask you to relax your muscles while they passively move your joints to further assess the range of motion. While your joints are moving we will also be assessing for crepitus, which is a high-pitched screech or grinding that you can feel or hear in the joint when bone rubs directly on bone.
This sound can indicate that inflammation in the joint has worn down the tissue inside such that the ends of the joints are rubbing on each other. Lastly, we will also check for any signs of damage or looseness in the joints by stressing the ligaments (the tissues that attach bone to bone.)
If your Physical Therapist deducts from the history and physical examination that your problem is potentially due to RA, we will refer you on to your doctor for further examination and investigations.
No single test can confirm a diagnosis of RA. Many findings over a period of time lead to the diagnosis. Early on, many characteristics of RA haven't developed yet, such as the pattern of joints that are affected, X-ray findings, and blood test changes. RA in its early stages can look a lot like other orthopaedic problems or other forms of arthritis, such as lupus, psoriatic arthritis, and diseases of the spine or simple orthopaedic problems. Your doctor will need to consider each of these diagnoses and perhaps do tests to rule them out.
To confirm the presence of inflammation in the synovial membranes, which occurs in all patients with RA, your doctor can do a count of the white blood cells (WBC) in your synovial fluid. This test involves inserting a thin needle into your joint and drawing out a small amount of the fluid for testing. The fluid can also be tested for other things. The WBC alone, however, doesn't prove that you have RA. Synovitis of the joints can occur even if you don’t have RA, therefore your doctor will need to rule out other causes of synovitis.
Your doctor will also ask you to undergo a blood test. As mentioned previously, RF, or rheumatoid factor, is found in the blood of about 85 percent of RA patients. This test alone can't confirm RA either. Some patients with RA do not have RF, and people with RF can have other forms of arthritis.
Another test your doctor can determine from your blood is the erythrocyte sedimentation rate (ESR, or sed rate), which measures how fast red blood cells settle in the test tube. Red blood cells that settle faster than normal indicate inflammation in the body. The ESR varies greatly between people. It is even possible for a patient with RA to have a normal ESR. The ESR may be more useful in monitoring the progress of RA than in diagnosing it. A higher ESR, however, usually means that the inflammation is more severe.
The C-reactive protein test can also monitor inflammation. It is a newer test that may be more accurate than the ESR. This test measures the amount of a certain protein that is produced by the body due to inflammation. When inflammation is very active the amount of C-reactive protein is high, and when inflammation is brought under control the level of protein decreases.
At some point, your doctor will probably ask you to get X-rays of your affected joints and organs. X-rays and other imaging techniques can show damage to the cartilage and bone as well as swelling in the soft tissues of the joint.
If you have rheumatoid nodules your doctor may want to take a biopsy of them. During the biopsy, a small amount of the nodule is removed and examined in a laboratory.