These signs and symptoms may offer clues to the seriousness of your rheumatoid arthritis.
One of the tricky things about treating rheumatoid arthritis is that this inflammatory autoimmune disease doesn’t progress the same in everyone who has it.
“I don’t know when I see someone over the first two or three visits how serious it will be,” says John J. Cush, MD, director of clinical rheumatology for Baylor Scott & White Research Institute and a professor of medicine and rheumatology at Baylor University Medical Center at Dallas.
Despite all the research that’s been done, who may develop severe RA and joint damage and whose joint damage will slow over time still remains somewhat of a medical mystery.
Guidelines from the American College of Rheumatology suggest that certain measurements, along with other tests, can help give you and your doctor a map as to how your rheumatoid arthritis disease may progress. Here are five things doctors look for:
1. The Number of Swollen, Painful Joints You Have
The more joints that are painful and swollen, the more severe the disease may be, says Dr. Cush. Joint pain and swelling are characteristic symptoms of rheumatoid arthritis. Rheumatologists consider this a very important way to measure disease severity.
Your doctor should examine joints in your hands, feet, shoulders, hips, elbows, and other spots to see how many are causing problems. Symmetrical symptoms, such as having the same swollen joints on both sides of the body, are also hallmark signs of RA, Cush says.
2. Rheumatoid Factor Blood Test Results
Rheumatoid factor (RF) is an antibody found in the blood that can trigger inflammation that may cause joint damage. While it’s a historic marker of the disease, new research shows that the presence of rheumatoid factor in the blood is not required for a doctor to make a rheumatoid arthritis diagnosis.
People whose blood tests don’t indicate RF or ACPA (some patients have ACPA positive and negative RF) have the seronegative form of the disease. As many as 80 percent of all people who have RA are considered seropositive because of their rheumatoid factor blood levels. The conventional wisdom is that those who have seronegative RA have milder symptoms, but a June 2016 article in BMC Musculoskeletal Disorders found that further research is needed to better understand the long-term outcomes of patients with seronegative rheumatoid arthritis.
3. ACPA Blood Test Results
This blood test checks for antibodies to a protein called citrulline. A positive anti-citrullinated peptide antibody (ACPA) test is a more specific marker for RA than rheumatoid factor, and is found in 70 to 80 percent of patients with the disease.
“ACPA testing detects peptides that are involved in key elements of the onset of the disease, and it is part of an association with a genetic risk factor for the disease,” says Cush. High levels of this antibody appear to be associated with more serious disease progression, but as with RF, the presence of those antibodies are not necessary for a doctor to make an RA diagnosis.
4. Imaging Test Results
X-rays, CT scans, MRIs, and ultrasounds are all tests that can help track and detect the severity of joint and cartilage damage. Bone erosion and destruction of cartilage can happen quickly within the first two years you have rheumatoid arthritis, and they may continue to develop over time.
5. Your Perception of Your Quality of Life
Rheumatoid arthritis is one of the few diseases where subjective measures of how a patient feels are among the best predictors of how well a person will respond to treatment and how much the disease will progress. Doctors may measure severity of symptoms using both the Health Assessment Questionnaire Disability Index (HAQ) and the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire.