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Making a diagnosis of arthritis can be difficult, and this article outlines the four different steps that physicians go through to make a diagnosis of this disease.

Arthritis is an inflammatory condition that can develop in patients of any age. If you display symptoms that are characteristic of arthritis, such as inflammation of joints, then your family doctor will refer you to a specialist known as a rheumatologist. The rheumatologist will then make a diagnosis of the disease.

Unfortunately, arthritis can be hard to diagnose as there is not one test that can confirm the presence of this disease. Physicians generally use a combination of different steps to diagnose patients. These are the steps that your rheumatologist will take when it comes to diagnosing you ith the disease.

Step 1: Ask questions about the symptoms

The best to way to get started when it comes to making any sort of diagnosis is to ask questions, which can include:

  • What are your symptoms?
  • When did your symptoms begin?
  • Where do you feel pain?
  • When do you feel stiffness of joints: in the morning, after a period of rest or after a period of activity?
  • How long does the pain or stiffness of joints last?
  • Do you feel symptoms constantly or do they come and go in flares?
  • Does your pain respond to any over-the-counter medications?
  • Have your symptoms gotten worse over time?

Step 2: Ask about personal and family medical history

The doctor will likely ask questions about your recent medical history as well your family’s medical history as arthritis can run in families. These are the kinds of questions they may ask:

  • Have you recently or in the past been sick?
  • Have you traveled anywhere in the past year?
  • Have you injured your joints over the past year or at some other point?
  • Do you play a lot of sports? Do you play any contact sport?
  • Have you been injured recently or in the past?
  • Do you suffer from mental illness or depression?
  • Are you and your family healthy? What kind of diet do you eat?
  • Does anybody in your family smoke?
  • Does anybody else in your family suffer from arthritis? If so, what age did their arthritis start? Did they ever get a genetic test?
  • Does anybody else in your family have any other types of autoimmune disease?

Step 3: Conducting a physical examination

In order to assess the inflammation of joints, your doctor will conduct a physical examination of your joints to determine which joints are involved and the level of severity of the disease. They will look for visible signs that are indicative of joint inflammation such as swelling, redness and warmth. The doctor will fully evaluate exactly which joints are involved in the disease. The doctor will also test for range of motion by moving your joints back and forth. The examination will also involve the rheumatologist prodding around the joint to see which are the tenders areas. The doctor will also do the following things in the physical examination:

  • Check the temperature of the patient
  • Check for swollen glands
  • Look into the eyes and throat
  • Check for reflexes

Step 4: Order tests

Next, the doctor will likely order different types of tests such as blood and imaging tests. While these tests are not going to be able to diagnose arthritis, they are going to be able provide further evidence for the disease and exclude other diseases. These are the different types of tests that the doctor can order:

Blood tests

In patients with arthritis, blood tests are often used to look for markers of inflammation and presence of autoimmune disease. Blood tests are going to look for:

  • Erythrocyte sedimentation rate. This is the rate at which red blood cells settle down at the bottom of a test tube. Generally, the longer it takes for the red blood cells to settle, the higher the level of inflammation is. This test essentially just tells you whether you are experiencing inflammation
  • C-reactive protein. Levels of c-reactive protein are elevated in people with inflammatory diseases. Again, while this test won’t tell you if you have arthritis, it will tell you if you have inflammatory disease.
  • Rheumatoid factor. This is an antibody that is present in a subset of patients with arthritis. If you have rheumatoid factor, there is a good chance you have arthritis, but you can also have another autoimmune disease.
  • Anti-nuclear antibody. This is another type of antibody that can be present in people with autoimmune disease. Again, this is not specific for arthritis.
  • Complete blood count. Patients with arthritis can have low levels of red blood cells, which is a condition known as anemia.

Imaging tests

These are the different imaging tests that the doctor may order:

  • X-rays. This can help determine which joints are involved, the pattern of inflammation and the severity of disease activity.
  • MRIs. Similar to X-rays, MRIs provide a more detail image of the joints involved.

Using a combination of questions, physical examination and tests, the rheumatologist will be able to exclude other diagnoses and diagnose you with arthritis.

  • Watt, I. "Basic differential diagnosis of arthritis." European radiology 7.3 (1997): 344-351.
  • "Diagnosis and management of rheumatoid arthritis." American family physician 84.11 (2011): 1245.
  • Kunnamo, Ilkka, et al. "Clinical signs and laboratory tests in the differential diagnosis of arthritis in children." American Journal of Diseases of Children 141.1 (1987): 34-40.
  • Photo courtesy of SteadyHealth

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