How Do You Test for Rheumatoid Arthritis (RA)? Here’s How It Is Diagnosed

Rheumatoid arthritis (RA) is a type of arthritis. It causes painful swelling in your joints — especially in your hands and feet. RA is an autoimmune condition. When you have RA, your immune system causes too much inflammation in your body and it impacts your joints. This sets it apart from more common types of arthritis like osteoarthritis, which is due to wear and tear as you get older.

RA can be hard to diagnose since there’s no single test for it. In fact, if your symptoms and physical exam point to RA, you may be diagnosed without any tests at all. 

How is rheumatoid arthritis (RA) diagnosed?

Diagnosing rheumatoid arthritis (RA) can involve several different tests and evaluations, including:

• A physical examination

• Your symptom history

• Blood work

• X-rays

• Ultrasounds

• MRIs

To diagnose RA, healthcare professionals use clues from your symptoms and physical exam. Blood tests and imaging can give more information. But your symptoms and the physical exam are the most important parts of making the diagnosis. 

Diagnosing RA is quite complex. For example, it’s possible to have RA even if your test results are normal (more on this below). And it’s possible to have abnormal test results and not have RA. 

If that sounds confusing, that’s because it is. But rheumatologists (RA specialists) are trained to sort this all out.

What are the symptoms and physical exam findings of rheumatoid arthritis?

Common signs and symptoms of rheumatoid arthritis (RA) include:

• Joint pain

• Swollen joints

• Joint stiffness (lasting 30 minutes or more a day)

• Fatigue

RA can affect almost any joint in your body, but it’s most common in your hands and feet. These symptoms need to last for at least 6 weeks before RA can be considered.

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Of note, RA doesn’t usually cause back pain. It typically only affects one joint in your spine — at the top, near the base of your skull. When RA affects this joint, it may cause a headache near the back or bottom of your head, but not back pain. 

What tests can help diagnose rheumatoid arthritis?

The following is a closer look at tests that can help when trying to diagnose rheumatoid arthritis (RA). But it’s important to remember that no single test can confirm or rule out RA. Your symptoms and physical exam findings are what matter most.

Blood tests 

Two blood tests may help diagnose RA if the symptoms and physical exam also fit:

• Rheumatoid factor (RF) 

• Anti-cyclic citrullinated peptide (anti-CCP) 

Some people with RA have both positive RF and anti-CCP tests. A positive test means these substances are present in your blood. Some people only have one positive test. And about 1 in 4 people with RA don’t have any positive tests. When both blood tests are negative, it’s called seronegative rheumatoid arthritis. “Sero” means blood, so “seronegative” means that the blood tests are negative.

Some people who test positive for these markers don’t have RA. This is known as a false positive, which means the test result is incorrect. False positives can happen for other reasons. For example, chronic hepatitis C is one of many conditions that can also cause a positive RF. That’s why positive testing alone doesn’t mean you have RA. You must also have symptoms that match. 

A positive anti-CCP test may mean you’re at an increased risk of developing RA in the future. It doesn’t mean that you have RA now. But if you later develop symptoms, it’s important to connect with your healthcare team.

X-rays

If the diagnosis is unclear, X-rays may help provide clues about RA. RA may damage joints in as little as 1 year if left untreated, and X-rays can show these joint changes. RA affects your joints in a unique way, so an X-ray can help support an RA diagnosis.

Magnetic resonance imaging (MRI)

For a more detailed view of your joints, an MRI may be a better option for some people. It may be helpful for people who have RA symptoms but no signs like swelling on a physical exam. But if your joints are clearly swollen during the exam, an MRI isn’t usually needed.

Ultrasound

This quick imaging test can detect inflammation in your joints. Ultrasounds are also helpful for people with symptoms of RA but a normal physical exam. Sometimes, your doctor can do an ultrasound during your physical exam. It’s also cheaper and faster than an MRI.

Who should be tested for rheumatoid arthritis?

If you’ve had symptoms of rheumatoid (RA) for more than 6 weeks, tell a healthcare professional. They’ll likely order blood tests and imaging to get things moving. More importantly, they can refer you to a rheumatologist to confirm your diagnosis. 

Remember, negative tests don’t rule out RA. If your tests are negative but your symptoms and physical exam suggest RA, you may have seronegative RA. That’s why seeing a rheumatologist is so important. 

Risk factors for rheumatoid arthritis

RA is most common in your 50s and 60s, but it can affect anyone, at any age — even kids. Some factors may increase your risk of developing RA. These include:

• Having a first-degree relative with RA

• Smoking

• Being female 

What to expect if you are diagnosed with rheumatoid arthritis

A diagnosis of RA may feel overwhelming at first. But once you have a diagnosis, you and your rheumatologist can focus on getting you better. 

RA is a chronic condition, which means there’s no cure yet. But it’s very treatable. There are multiple treatment options, and feeling better is a very realistic goal. 

Treatment of RA involves immunosuppressants — medicines that decrease inflammation caused by your immune system. Common examples include:

• Methotrexate

• Humira

• Xeljanz

Rheumatologists are the experts when it comes to prescribing RA medications. But it can take time to get an appointment. Some people may not have access to a rheumatologist at all. 

If this is the case, don’t worry. Your primary care provider can also help you start treatment.

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Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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