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Tests for diagnosis of RA

There is a growing list of blood tests that help determine the diagnosis of RA.

My Erythrocyte Sedimentation Rate (ERS) and C-reactive protein (CRP) were off the charts. Both measure inflammation in the body.

Yet, I was negative for the Rheumatoid factors, a variety of antibodies frequently present in people with RA. I was also negative for the anti-CCP antibodies, used to predict RA. I did have at least 15 joints inflamed for at least several months. Together the extremely high inflammatory markers plus the number of inflamed joints made the diagnosis an easy one.

There was also a test to rule out Lupus. It is the ANA profile. If it is negative, you don’t have Lupus. Mine was negative. CBC, metabolic panel, tests for thyroid function are also given. I had a chest x ray and x rays of my hands and feet.

I feel thoroughly tested.  On going tests are the ERS and the CRP to check inflammation and treatment progression.  The metabolic panel keeps track of liver and kidney function.  The CBC checks the levels of red and white blood cells plus platelets, hematocrit and hemoglobin. These are done about every month.

The following is criteria for diagnosis of RA for research purposes

You can find the full report for this classification criteria online. This is a summery of that report that was posted on Wikipedia.

In 2010 the 2010 ACR / EULAR Rheumatoid Arthritis Classification Criteria were introduced. These new classification criteria overruled the “old” ACR criteria of 1987 and are adapted for early RA diagnosis.

The “new” classification criteria, jointly published by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR)establish a point value between 0 and 10.  Every patient with a point total of 6 or higher is unequivocally classified as an RA patient, provided he has synovitis in at least one joint and given that there is no other diagnosis better explaining the synovitis. Four areas are covered in the diagnosis:

  • joint involvement, designating the metacarpophalangeal joints, proximal interphalangeal joints, the interphalangeal joint of the thumb, second through fifth metatarsophalangeal joint and wrist as small joints, and shoulders, elbows, hip joints, knees, and ankles as large joints:
    • Involvement of 1 large joint gives 0 points
    • Involvement of 2-10 large joints gives 1 point
    • Involvement of 1-3 small joints (with or without involvement of large joints) gives 2 points
    • Involvement of 4-10 small joints (with or without involvement of large joints) gives 3 points
    • Involvement of more than 10 joints (with involvement of at least 1 small joint) gives 5 points
  • serological parameters – including the rheumatoid factor as well as ACPA – “ACPA” stands for “anti-citrullinated protein antibody”:
    • Negative RF and negative ACPA gives 0 points
    • Low-positive RF or low-positive ACPA gives 2 points
    • High-positive RF or high-positive ACPA gives 3 points
  • acute phase reactants: 1 point for elevated erythrocyte sedimentation rate, ESR, or elevated CRP value (c-reactive protein)
  • duration of arthritis: 1 point for symptoms lasting six weeks or longer

The new criteria accommodate to the growing understanding of RA and the improvements in diagnosing RA and disease treatment. In the “new” criteria serology and autoimmune diagnostics carries major weight, as ACPA detection is appropriate to diagnose the disease in an early state, before joints destructions occur. Destruction of the joints viewed in radiological images was a significant point of the ACR criteria from 1987. This criterion no longer is regarded to be relevant, as this is just the type of damage that treatment is meant to avoid.


  1. Awesome information. I was told I had beginning of RA from one Dr. Just met my new one and he is running all of these tests. I know for sure I was negative for Lupus and had a positive but low number for rheumatoid factors. This new dr. told me he will have results in 3 weeks, now I wait. 😦 Any other books you would recommend? You are so knowledgable!


    • Keep me posted on your results.
      I have read three other books but don’t feel they were worth recommending for various reasons.
      Do recommend you look at Kelly’s blog http://RAWarrior/
      She has a lot of stuff. Some you will enjoy and some might be too much. She is an advocate of those having a hard time with RA.


      • I just got called into the doctor, he said that he believes I have a rare disease called wageners granulomatosis and possibly not RA. I still test positive for RA though so I am not totally sure what this all means.This is still an autoimmune disease affecting my joints, along with my lungs, sinuses, blood vessels, and kidneys. I won’t have confirmation until after having a biopsy. Thank you for all the information.


      • Sounds like you have a new challenge to deal with. You had an excellent approach to RA. You will do the same with Wegeners.
        The RA antibodies can be present in other disorders. It is valued in RA because about 70% test positive for it at some point.
        Sounds like you have a good doctor. That is so valuable.
        My heart goes out to you for the challenges you are facing. Keep in touch.


  2. This is such important info…thanks for sharing it. After the labs came in that my PCP ordered, she said I tested positive for the rheumatoid factors, negative for lupus…but now I see there are many more tests I will likely have to undergo once I meet with the rheumatologist…soon, I hope.


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