Condition Guide

Rheumatoid Arthritis (RA)

Name: Rheumatoid Arthritis: Symptoms, Blood Tests & Treatment
Creator: Suman Konda
Published: 2026-07-05

Rheumatoid arthritis is an autoimmune disease where the immune system attacks the joints. Early diagnosis and treatment with DMARDs can prevent permanent joint damage.

Written by Suman Konda, PharmD, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last updated: 01 August 2026 · How we check our content

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that primarily attacks the synovium: the lining of joints. Unlike osteoarthritis (wear and tear), RA is driven by the immune system mistakenly attacking healthy joint tissue, causing inflammation that eventually damages cartilage and bone. RA affects about 1% of the global population and is 2–3 times more common in women. It most commonly begins between ages 30–60.

Blood tests for RA diagnosis and monitoring

Test	Normal	What it shows in RA
Rheumatoid Factor (RF)	<14 IU/mL	Positive in 70–80% of RA; not specific
Anti-CCP antibodies	<20 U/mL	Positive in ~95% of RA; highly specific
CRP	<10 mg/L	Active inflammation; tracks disease activity
ESR	<20 mm/hr (women), <15 (men)	Ongoing inflammation
CBC	Normal	Anaemia of chronic disease common in RA
Liver function	Normal at baseline	Monitored during DMARD therapy

Seropositive vs Seronegative RA

Seropositive RA: both RF and anti-CCP positive. Generally more severe disease with higher risk of joint destruction and extra-articular complications (lung disease, vasculitis, nodules). Seronegative RA: RF and anti-CCP negative. Diagnosis based on clinical features. May have slightly milder course but still requires treatment.

Symptoms of RA

Symmetrical joint swelling: both hands, both wrists (not one side like gout)
Morning stiffness lasting more than 1 hour (key distinguishing feature from osteoarthritis)
Warm, tender, swollen joints
Fatigue and low-grade fever
Small joints of hands and feet involved first
Rheumatoid nodules: firm lumps under the skin near elbows
Weight loss in active disease

DAS28: measuring disease activity

The Disease Activity Score (DAS28) is used to track RA severity and guide treatment. It combines joint counts, CRP or ESR, and the patient's own assessment of disease activity. Scores: <2.6 = remission; 2.6–3.2 = low disease activity; 3.2–5.1 = moderate; >5.1 = high activity.

Treatment overview

Treatment	Stage	Notes
NSAIDs	Symptom relief	Does not slow disease progression
Corticosteroids (short course)	Acute flares	Rapid relief; long-term side effects
Methotrexate	First-line DMARD	Gold standard; weekly dose + folic acid
Hydroxychloroquine / Sulfasalazine	Mild RA or combination	Often used with methotrexate
Biologics (TNF inhibitors, JAK inhibitors)	Moderate–severe RA not controlled by DMARDs	Adalimumab, etanercept, tofacitinib

Questions to ask your doctor

Are both my RF and anti-CCP positive?
What is my DAS28 score?
Should I start methotrexate?
How often should I monitor my blood tests on DMARDs?
Do I need hand X-rays to check for joint erosions?

References

The clinical information on this page is drawn from peer-reviewed sources indexed by the US National Library of Medicine. Links go to the source so you can read it yourself.

Erythrocyte Sedimentation Rate. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK557485
Rheumatoid Factor. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK532898