If you’re like most patients in our community, you are extremely vigilant about tracking health numbers to monitor your rheumatoid arthritis (RA). However, in today’s world of abundant data, at-home tests, and extensive lab results from the doctor’s office, it can be difficult to pinpoint which health numbers are the most important to track.
Here are the five health numbers to keep in mind if you have RA — plus, how your doctor can help you interpret them and provide a big-picture view of your disease state.
Rheumatoid Factor (RF)
Rheumatoid factors (RF) are proteins made by the immune system — and a RF test looks for them in a sample of your blood, per the National Library of Medicine. You may hear about RF testing during the process of receiving a RA diagnosis.
Usually, your immune system creates proteins called antibodies to attack germs that could make you ill, but rheumatoid factors are antibodies that sometimes mistakenly attack your healthy cells and tissues.When that happens, you have an autoimmune disorder. Of course, some people who have rheumatoid factors in their blood are healthy. But when they’re found in higher levels and paired with certain symptoms, they may point to a condition such as RA.
RF testing is used along with other tests to help diagnose RA. High levels of rheumatoid factors can also signal other autoimmune disorders, certain infections, and certain types of cancer.
“We use a lot of different numbers in rheumatoid arthritis, but one of the most important would be rheumatoid factor,” says Alireza Meysami, MD, Division Head of Rheumatology at Henry Ford Health System and Associate Professor of Medicine at Wayne State University. “The presence of these antibodies could be suggestive of more damaging or aggressive disease.”
During an RF test, a health care professional will take a blood sample from your arm and store it in a test tube or vial. You don’t have to make any special preparations for an RF test. At-home tests are also available and collect blood via a sample of blood from a finger prick. In this case, you’ll mail your sample to a lab for testing, but it’s still very important that you discuss the results with your doctor.
“If the patient does not seek help or interpretation from a health care provider, these numbers could actually be scary,” says Dr. Meysami. “It’s important to know the status of these numbers, but the interpretation of the numbers must be done by a health care provider. One positive test, for instance, does not mean that a patient is in trouble or that their overall health is in danger.”
Likewise, a negative result means you have little or no rheumatoid factors in your blood, but it doesn’t rule out RA or another health problem.
Although it’s unknown in RA if changes in autoantibody levels are associated with disease activity and treatment results, or if levels are modified by the intensity of immunosuppressive therapy, most studies have found that RF levels decrease after the start of treatment with different DMARD drugs, per a 2019 study in Arthritis Research & Therapy. Autoantibody stability in different autoimmune diseases varies quite a bit, with some autoantibodies fluctuating with disease flares.
That said, some doctors don’t find RF testing to be an important tool beyond your initial diagnosis.
“When the rheumatoid factor represents rheumatoid arthritis, it helps with diagnosis, but it doesn’t help with clinical monitoring or surveyance,” says Amro Balki, MD, board-certified rheumatologist at Providence Saint John’s Health Center in Santa Monica, CA. “When we monitor and treat patients over time, we never repeat the rheumatoid factor test. It’s a common mistake from other providers who are not rheumatologists, or sometimes upon request from the patient, to repeat the test when it’s not helpful clinically.”
Your doctor will likely also monitor your levels of C-reactive protein levels and sedimentation rate as they monitor your disease.
C-reactive protein (CRP) is often assessed as a marker of systemic inflammation in rheumatoid arthritis and CRP levels appear to be associated with common comorbidities of rheumatoid arthritis, per a 2021 report in Seminars in Arthritis and Rheumatism. CRP levels also appear to play a direct role in bone destruction and disease progression in rheumatoid arthritis.
Meanwhile, sedimentation rate (ESR) is another measure of inflammation. It’s calculated by measuring how quickly red blood cells sediment in a test tube in one hour, per the Hospital for Special Surgery (HSS).
“Both of these tend to be elevated when the condition is active, because they do represent that there is inflammation in the body,” says Dr. Balki. “That said, sometimes they can be normal when the condition is active, and sometimes, they can be slightly elevated when it’s in remission, so the metrics are complex.”
These markers of inflammation may serve as clues that the disease might be active and your doctor will evaluate them alongside other factors, like your symptoms.
Doctors may also use a complete blood count test, which looks at red and white blood cell counts, to learn about potential side effects of your treatment and any secondary effects of rheumatoid arthritis like anemia. Your doctor may also order a complete metabolic panel to monitor liver and kidney functions, since these can also be affected by medication, per the HHS.
Research shows that inflammatory arthritis like rheumatoid arthritis is related to a higher risk of both type 1 and type 2 diabetes (learn more about the complicated relationship between diabetes and arthritis).
Both rheumatoid arthritis and type 1 diabetes are autoimmune diseases — and research shows about 25 percent of individuals with one autoimmune disease later develop at least one more.
And although more studies are needed to fully understand why, certain factors like inflammation, arthritis medications, and inactivity may play a role in the association between inflammatory arthritis and type 2 diabetes.
“Patients with rheumatoid arthritis are also often exposed to a steroid, so they’re at high risk of having diabetes,” says Dr. Meysami. Steroid-induced diabetes is defined as an abnormal increase in blood glucose associated with the use of glucocorticoids (steroid hormones widely used for autoimmune diseases) in a patient with or without a previous history of diabetes, per a 2014 article in Diabetes/Metabolism Research and Reviews.
In any case, your doctor may want to keep a close eye out for warning signs of diabetes, which could include monitoring your blood sugar levels.
Hypertension, or high blood pressure, is more common in patients with rheumatoid arthritis — but the underlying mechanisms aren’t clear, per a 2013 study in The Journal of Rheumatology.
However, some research points toward inflammation playing a role. Inflammation is associated with elevated blood pressure in the general population and it can be 10-fold higher in those with rheumatoid arthritis, per a 2018 study in Arthritis Research & Therapy.
Rheumatoid arthritis poses a higher risk of cardiovascular disease and those with RA are less likely to be diagnosed with hypertension even if symptomatic, per the University of Wisconsin School of Medicine and Public Health. That makes it particularly important to keep your doctor in the loop about your blood pressure levels.
“You want to be sure to maintain a healthy blood pressure because of this risk,” says Dr. Meysami.
When your blood pressure is high for too long, it damages the blood vessels and LDL (“bad”) cholesterol begins to accumulate in your artery walls. This can put you at risk for life-threatening heart conditions, per the American Heart Association. In fact, high blood pressure can lead to stroke, heart failure, kidney disease, heart attack, and other conditions like vision loss and sexual dysfunction.
Your doctor may also watch your BMI (body mass index) closely, since being overweight can put stress on joints and raise your risk of heart disease. Note: Many health care providers consider BMI an outdated measure and will instead work with you on finding a healthy weight for you.
On the note of heart disease, you should also work with your primary doctor to keep track of your cholesterol levels over time. This is likely part of your routine checkups already but is particularly important if you have RA.
“Metrics like these aren’t used to assess rheumatoid arthritis disease activity, but they are important to be checked and monitored with the primary care doctors,” says Dr. Balki. “We know that patients with chronic inflammation like that from rheumatoid arthritis tend to have higher risk of high cholesterol and cardiovascular risk over time.”
If your cholesterol levels are elevated, your doctor may recommend lifestyle changes like improving your diet and exercising more or medication (if lifestyle changes aren’t enough).
Are You Too Preoccupied with Your Numbers?
It’s important to stay aware of your health numbers so you can discuss courses of treatment with your doctor, but being conscientious isn’t healthy if it turns into a constant source of stress or leads you down an unproductive rabbit hole of Google searches.
“In general, all you need to do is focus on a better lifestyle, not about numbers that much,” says Dr. Meysami. “These are just tools to help a provider put everything into context, look at the big picture, and come with a conclusion — none of these things alone would have much meaning.”
Other factors, like stress, can cause several of these numbers to be elevated (including inflammatory markers and blood pressure). Plus, qualitative factors like pain, fatigue, joint stiffness, and overall well-being are factors that are crucial to understanding your disease state, even though they aren’t typically measured by numbers.
“That’s very important for us to understand a patient better and have a comprehensive evaluation,” says Dr. Meysami. “Without these, the numbers have no value.”
Remember, your doctor is there to help you interpret your health numbers. You’re not in this alone — and when you maintain communication with your doctor about your quantitative metrics and other symptoms, you’ll both be in the best position possible to monitor and improve your health.
Global Healthy Lifestyle Events
Our beloved CreakyKitchen virtual events are back and better than ever! This year we are introducing Global Healthy Lifestyle Events, which will be filled with nutrition, exercise, and mindfulness activities. The heart and soul of the events will be the same: we will gather online as a community to connect, laugh, and make memories together.
Join us on Zoom tonight, on Tuesday, July 25th at 7pm ET, for the first in a series of three events. The inaugural event, titled From Blood Pressure to Blood Sugar: Why Knowing (and Managing) Your Numbers Matters, will feature practical strategies for effectively managing your numbers with easy lifestyle interventions. Sign up now.
de Moel EC, et al. In rheumatoid arthritis, changes in autoantibody levels reflect intensity of immunosuppression, not subsequent treatment response. Arthritis Research & Therapy. January 18, 2019. doi: https://doi.org/10.1186/s13075-019-1815-0.
Interview with Alireza Meysami, MD, Division Head of Rheumatology at Henry Ford Health System and Associate Professor of Medicine at Wayne State University
Interview with Amro Balki, MD, board-certified rheumatologist at Providence Saint John’s Health Center in Santa Monica, Calif.
Health Threats from High Blood Pressure. American Heart Association. March 4, 2022. https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure.
Hwang JL, et al. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes/Metabolism Research and Reviews. July 27, 2014. doi: https://doi.org/10.1002/dmrr.2486.
Manavathongchai S, et al. Inflammation and Hypertension in Rheumatoid Arthritis. September 1, 2013. The Journal of Rheumatology. doi: https://doi.org/10.3899/jrheum.130394.
Pope JE, et al. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Seminars in Arthritis and Rheumatism. February 2021. doi: https://doi.org/10.1016/j.semarthrit.2020.11.005.
Rheumatoid Factor (RF) Test. National Library of Medicine. Accessed April 4, 2023. https://medlineplus.gov/lab-tests/rheumatoid-factor-rf-test/.
Understanding Rheumatoid Arthritis Lab Tests and Results. Hospital for Special Surgery. September 10, 2020. https://www.hss.edu/conditions_understanding-rheumatoid-arthritis-lab-tests-results.asp.
Yu Z, et al. Association between inflammation and systolic blood pressure in RA compared to patients without RA. Arthritis Research & Therapy. June 1, 2018. doi: https://doi.org/10.1186/s13075-018-1597-9.
What the New Blood Pressure Guidelines Mean for Rheumatoid Arthritis. University of Wisconsin School of Medicine and Public Health. March 8, 2018. https://www.medicine.wisc.edu/news/what-new-blood-pressure-guidelines-mean-rheumatoid-arthritis.