A common scenario in Chicago Arthritis’ clinic involves patients experiencing pain for a few months. These patients often have normal lab results and are told they don’t have rheumatoid arthritis. But is this accurate? Let’s explore this.

Antibody and Inflammation Levels

At the initial diagnosis of rheumatoid arthritis, 50% of patients will actually be antibody-negative. Often, their levels of inflammation will also be negative. Rheumatoid arthritis is a clinical diagnosis that considers not only lab results but also exams, imaging findings, and symptoms. This condition involves an overly active immune system causing joint inflammation, and there isn’t a single test that provides a definitive diagnosis.

The Role of Imaging

Positive antibodies or lack of antibodies do not necessarily indicate disease activity. To determine active inflammation, examinations or imaging, such as ultrasound or MRI, are necessary. X-rays, while often used for pain complaints, do not show inflammation. They reveal fractures, wear and tear arthritis, and sometimes chronic damage in RA but are not helpful for early RA diagnosis.

Clinical Diagnosis

If lab results are positive but there is no inflammation on exam or imaging, it is unlikely to be RA. Conversely, if lab results are negative but there is inflammation on examination or imaging, it may indicate inflammatory arthritis or seronegative rheumatoid arthritis, where labs are normal but clinical criteria for RA are met.

Key Symptoms

If lab results are negative but you have symptoms such as pain on both sides of the body, swollen joints, and prominent hand and wrist symptoms lasting more than six weeks, you might still have RA. A rheumatologist can help determine if there is objective inflammation and if you meet the criteria for RA.