How to diagnose rheumatoid arthritis?

Question

Hello doctor,

I have been having really bad morning stiffness in my fingers and wrists for the past three months. It takes about two hours before I can properly move them. My joints feel hot and puffy, especially around my knuckles.

I am a musician, and I am terrified because it is getting harder to play. My grandmother had rheumatoid arthritis, and I am worried I might have it too. I am only 35.

Is not this too young?
What tests do I need to confirm if this is RA?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I am sorry to hear you are experiencing these symptoms, especially with how it is affecting your ability to play musical instruments. While rheumatoid arthritis (RA) can indeed run in families and can sometimes start as early as your 30s, this does not mean it is RA. But it is wise to get checked out, especially with the symptoms you are describing: morning stiffness lasting over an hour, joint swelling, and warmth are all signs that warrant further investigation.

To diagnose RA or rule it out, doctors typically order a combination of blood tests and imaging studies. Here is a rundown of what you may expect:

Blood Tests

Rheumatoid Factor (RF): This antibody is often elevated in people with RA, though not exclusively. A positive RF test does not confirm RA on its own, as it can be present in other conditions as well.
Anti-Cyclic Citrullinated Peptide (Anti-CCP) Antibodies: Anti-CCP is more specific for RA and often helps confirm the diagnosis, especially if RF is also positive.
Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP): These tests measure inflammation levels in the body. High levels suggest active inflammation, which is common in RA and other inflammatory conditions.
Complete Blood Count (CBC): This can help identify anemia or other blood abnormalities that sometimes occur with chronic inflammatory diseases like RA.

Imaging

X-rays: X-rays of your hands and wrists can reveal joint changes characteristic of RA, although early stages may not show up well.
Ultrasound or MRI (magnetic resonance imaging): These are more sensitive than X-rays and can detect inflammation and early joint changes, even in the early stages of RA. They can show synovitis (inflammation of the joint lining) and erosions, which are common in RA.

A rheumatologist specializes in joint disorders and can assess your symptoms, perform a physical exam, and interpret these tests accurately. RA is best treated when caught early, and a rheumatologist can start you on medications to control inflammation and protect your joints if you are diagnosed with RA. Early treatment can significantly reduce the risk of joint damage and help preserve hand function, which is especially important given your profession as a pianist.

Although RA is more common in people over 40, it can indeed begin in younger adults. Factors like family history and specific immune responses can contribute to its earlier onset.

If you are diagnosed with RA, there are treatment options like disease-modifying antirheumatic drugs (DMARDs) and newer biological therapies that can effectively control symptoms and slow disease progression. Starting these treatments early can make a significant difference in quality of life.

Kindly consult a physician, discuss with them, and start taking the medications with their consent.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.