Ask a person about their road to an arthritis diagnosis and you hear long stories about various doctor visits and multiple tests and procedures. This is because there isn’t any one blood test that can be used to diagnose an autoimmune disease such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). To complicate matters, the same disease can sometimes present differently in different patients. This can be frustrating for both the doctor as well as the patient, particularly because we know that the earlier people get diagnosed, the better their outcomes, such as disease control and symptom improvement.
Because there is no single test to diagnose and treat inflammatory types of arthritis, rheumatologists and patients must often act as detectives to arrive at a correct diagnosis. This may include employing a combination of methods such as physical exam, blood work and labs, radiographic imagery, and listening to, and recording, the patient’s experience over time via tools like patient-reported outcomes instruments or PROs (such as pain/fatigue assessments).
During this webinar, rheumatologist Robin K. Dore, MD, clinical professor of medicine at the David Geffen School of Medicine at UCLA, and in private practice in Tustin, California, will discuss the various methods doctors use to diagnose different types of arthritis. She will explain what different blood tests mean and what information they can (and cannot) provide. This information can arm you to better advocate for yourself and/or a loved one.
Fast Facts from the Webinar
1. Blood tests for patients with autoimmune conditions are used to diagnose, monitor and assess how they are responding to treatment.
But blood tests may not always provide clear information. That is why it is important to consider blood test results along with the patient’s history and their physical exam. This may include tender and swollen joint counts, lab tests and blood work, and imaging, such as X-rays and ultrasounds, when diagnosing, managing and treating chronic autoimmune and inflammatory diseases like RA, PsA, AS, Sjögren’s syndrome and lupus.
2. While useful, no rheumatic disease is established by blood tests alone.
Doctors also rely on patient information — how long has the patient experienced pain and stiffness, when does the stiffness arise, how long does it last, where is the pain experienced — when making a diagnosis and evaluating if a specific treatment is working for patients. It is important for patients to keep track of symptoms they can share with their doctors. Patients can do so using tracking apps like ArthritisPower.
3. Biomarkers are clues in our bloodwork
They provide important information to the doctor about whether a patient has a disease, how active the disease may be, and whether or not a specific treatment is working for the patient. Some examples of biomarkers are rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and anti-cyclic citrullinated peptide (anti-CCP). Your doctor may order some or all of these tests when trying to diagnose you.
4. In many autoimmune diseases, a positive test for a specific biomarker does not necessarily mean you have a disease
Therefore, some patients may have normal levels of biomarkers but still have the disease. For example, blood tests for RA are positive only 80 percent of the time. An individual could have RA even with a negative blood test. Some patients are diagnosed with seronegative rheumatoid arthritis, which is a rheumatoid arthritis diagnosis despite the absence of certain antibodies in the patient’s blood. A patient may also have an active autoimmune disease and yet a normal CRP score, which tends to be elevated in many persons with inflammatory conditions.
5. Osteoarthritis, which results from wear and tear of the joints, has no specific blood test to help in diagnosis.
In this case, doctors rely more on radiological evidence such as x-rays and ultrasounds.
6. Patients need to understand their labs.
It is important that the patient understands the significance of their own laboratory results. If the clinician does not routinely monitor laboratory studies or use patient reported outcomes, patients can advocate for more regular use of these tests for optimal care and management of their disease.
The Patient Perspective
Here’s what patient participants said they learned from this webinar:
- “There is not a single method to diagnose or treat autoimmune conditions. Excellent webinar.” — Gloria G.
- “I thought this was geared more for newly diagnosed or those still searching for a diagnosis, but also a reminder for those of us diagnosed decades ago, to still search for better treatment and understanding of our autoimmune diseases, new treatments and tests available, and to remember not to settle, but continue looking for a better outcome.” — Anita W.
About the Presenter
Robin K. Dore, MD, is a clinical professor of medicine at the David Geffen School of Medicine at UCLA, and in private practice in Tustin, California. She is a past chair of the Southern California Chapter of the Arthritis Foundation, past president of the Southern California Rheumatology Society, and past member of board of directors of the American College of Rheumatology. She is the immediate past president of the California Rheumatology Alliance and the board of directors of the Arthritis Foundation, and the board of managers at United Rheumatology. She is recognized for her contributions for patients, physician education, and community service, including the development of Bone Builders, a program devoted to educating girls and young women about the importance healthy lifestyles in the prevention of osteoporosis.