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General Medical Questions
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Question : Can a diagnosis for arthritis be made based on a blood test? If so, what should the doctor look for in the results?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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June 19, 2013
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The short answer is “no.” A diagnosis of arthritis cannot be made by blood tests.

Questions about tests for arthritis arise frequently. In part because it is a topic about which there is much misunderstanding. But it’s natural to have questions about it. And very common. It’s a topic that causes much misunderstanding.

The term “arthritis” means joint inflammation. And there is no way for a blood test to tell if there is joint inflammation. Instead, doctors determine the presence of arthritis by your symptoms and an exam of your joints. Blood test results can suggest a cause of arthritis. Or indicate that inflammation is present in the body. But blood tests themselves cannot establish any specific diagnosis.

The most commonly ordered tests for arthritis include:

  • The rheumatoid factor (RF)
  • Anti-cyclic citrullinated peptide (anti-CCP) antibody
  • Antinuclear antibody (ANA)
  • Erythrocyte sedimentation rate (ESR or “sed rate”)

The RF and anti-CCP are present in about 70% of people with rheumatoid arthritis. But these tests are often normal in people with milder disease. The RF is often present in people with other conditions, including some infections. So, you cannot rely on an RF blood test for diagnosis. However, the anti-CCP is rarely present in people without rheumatoid arthritis.

Similarly, the ANA, an antibody present in lupus and related conditions, often returns positive in people who have no evidence of lupus. The ANA is most helpful when it returns positive in the setting of suspected lupus. Or if it is not present (since that is strong argument against the diagnosis of lupus). But it rarely helps figure out the cause of arthritis unless other features of lupus are present.

If the ESR returns elevated, it suggests that there is inflammation in the body. Arthritis would be one cause. But there are many others, including infections. Even the common cold could raise the ESR. So it is not a very helpful test for arthritis.

Your doctor may suggest other evaluations, including x-rays, urine tests, and special testing for infections (such as Lyme disease). But as with all tests, your doctor must review your results along with a detailed medical evaluation.

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