Rheumatoid arthritis diagnosis

Rheumatoid arthritis diagnosis. Weight loss in RA is related to other disease symptoms. The disease typically affects multiple joints at once, especially in the hands and feet. You might have the disease for only a short time, or symptoms might come and go. Find out more about symptoms, causes, and treatment. In an autoimmune disease, your immune system starts attacking your own healthy tissues. Find a Doctor. Movement RA is a systemic condition, meaning that it can affect the body all over. Find out how to treat RA with early aggressive treatment, remission or target-to-target goals, and self-care strategies. Fatigue, fever and loss of appetite. The condition usually affects the hands, feet and wrists. This article will take a look at 6 commonly used tests and how they help doctors diagnose Criteria for Diagnosing Early-stage Rheumatoid Arthritis. This article discusses rheumatoid arthritis tests. Decreased range of motion. Laboratory and radiographic testing provide prognostic information more often than diagnostic information. 2. Patients with rheumatoid arthritis may experience acute pain due to injury, which can be caused by several factors. The following code (s) above M05. The immune system damages the joints and connective tissues. Early signs and symptoms of rheumatoid arthritis may include: 1 2. Jul 11, 2018 · This guideline covers diagnosing and managing rheumatoid arthritis. Most people with rheumatoid arthritis have chronic (long-lasting) symptoms. 9 contain annotation We would like to show you a description here but the site won’t allow us. The disease causes pain, swelling, stiffness, and loss of function in joints. These antibodies produce inflammation that attacks the How this topic was developed. Women get RA more often than men. Eventually, RA symptoms appear in all the major joints, including ankles, elbows, hips, knees, shoulders and wrists. Joint deformity. [1] Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. Patients Like You. Sep 5, 2018 · Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology. Many factors affect the outlook of people with RA, including age, lifestyle factors, and disease progression. Here are some RA symptoms you need to be aware of. . [1] The pattern of symptoms may wax and wane over the course of a day and even from one day to the next. References. Oct 16, 2023 · Rheumatoid arthritis, a progressive disease, causes symptoms such as joint pain and fatigue. While it can have painful and debilitating effects if left untreated, there are effective therapies to help control RA and its symptoms. So far, healthcare providers don't have a single test that definitively diagnoses RA, so they rely on a physical exam, family medical history Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints. Feb 18, 2022 · Rheumatoid arthritis is an autoimmune disease that causes pain, inflammation and deformity in your joints. RA commonly affects joints in the hands, wrists, and knees. Treatment helps stop disease, control symptoms, and prevent damage. Manifestasi yang muncul dapat berupa kaku sendi yang paling terasa di pagi hari, disertai dengan ketidaknyamanan Risks of Undiagnosed Rheumatoid Arthritis. The severe form can last a lifetime. Diagnosis involves a physical examination, a review of medical history, blood work, and imaging studies. 1. In general, a positive diagnosis of RA can be made if the following criteria are met: Nov 14, 2023 · Getting a rheumatoid arthritis diagnosis often involves a series of tests, including blood tests, imaging studies like X-rays or magnetic resonance imaging scans (MRIs), and a thorough physical examination to evaluate joint swelling, tenderness, and overall symptoms, to arrive at an official diagnosis. It is an autoimmune disease. This causes joint inflammation that is characterized by swelling, pain, redness, and stiffness. Get free rules, notes, crosswalks, synonyms, history for ICD-10 code M05. No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition. This Primer by Smolen et al. An X-ray is an inexpensive test that uses a type of radiation called electromagnetic waves to create images of the inside of the body. Rheumatoid arthritis symptoms & signs. Some of the main blood tests used include: The full blood count test can also be used to check if you have anaemia. 2 degrees F. Signs and symptoms of rheumatoid arthritis may include: Tender, warm, swollen joints. Managing Pain Relief. Unfortunately, it can sometimes be difficult to detect and diagnose RA because early symptoms are often subtle and nonspecific. RA occurs when the immune system attacks the lining of the joints, and this can cause pain, swelling and stiffness. Limping (In younger children, it may appear that the child is Jan 4, 2023 · Rheumatoid arthritis causes pain, swelling, and inflammation in joints and can affect organs throughout the body. The 2024 edition of ICD-10-CM M05. Dokter akan terlebih dahulu menanyakan keluhan dan riwayat penyakit, kemudian melakukan pemeriksaan fisik. Rheumatoid arthritis. Everyone’s experience living with RA is different, but having information Apr 14, 2023 · Arthritis refers to inflammation of a joint. Find out the difference between seropositive and seronegative RA, and how to rule out other conditions. 4 to 102. Delayed rheumatological referral is associated with less favourable long-term outcomes. This is the American ICD-10-CM version of M05. As with other illnesses, diagnosis of RA typically begins with your doctor getting your medical Mar 2, 2023 · Rheumatoid Arthritis. Rheumatoid arthritis (RA) is an autoimmune disease that causes pain, swelling and loss of joint function. A rheumatoid arthritis (RA) diagnosis may involve seeing a specialist, along with blood and imaging tests. M06. 79. In the early stages, the symptoms can look like those of other conditions like lupus or other connective tissue diseases. Untreated, it will lead to loss of physical function, inability to carry out daily tasks of living, and difficulties in maintaining employment. JIA is arthritis that affects 1 or more joints for at least 6 weeks in a child age 16 or younger. RA most commonly af ects the joints of the hands, feet, wrists, elbows, knees and ankles. [1] It typically results in warm, swollen, and painful joints. It explains the common lab tests and imaging studies used to make an RA diagnosis. Find out how doctors rule out other conditions that resemble RA and what you can do to manage your symptoms. The diagnosis also depends on excluding other explanations for the symptoms. Symptoms can also come and go. The most common types of arthritis are osteoarthritis and rheumatoid arthritis. This means the immune system of the body mistakenly attacks healthy tissue. When to suspect RA. Rheumatoid arthritis is different from osteoarthritis, the common arthritis that often comes with older age. Feb 7, 2024 · Rheumatoid arthritis affects about 1% of people around the world. Sometimes “flares” of RA are experienced as an increase in these systemic symptoms more than discrete joint swelling or tenderness. The 2024 edition of ICD-10-CM M06. It is diagnosed clinically after the exclusion of other diseases if the symptoms and signs are suggestive. RA may cause you to feel unusually tired, to have occasional fevers, and to have a loss of appetite. +1-410-502-7683 International. https Rheumatoid arthritis ditandai dengan bengkak, nyeri, dan kaku pada sendi. Gejalanya terkadang mirip dengan penyakit lain 2 days ago · Rheumatoid arthritis (RA) is a chronic autoimmune disorder that affects millions of individuals worldwide, causing joint inflammation, pain, and potential disability. In Mar 29, 2017 · Rheumatoid arthritis is an autoimmune disorder in which the body's immune system turns on itself and creates antibodies to its own cells. The main symptoms of rheumatoid arthritis are: joint pain. Symptoms include pain, swelling, and stiffness of the joints. However, it can also affect organs, soft tissue and cause widespread symptoms such as fatigue and flu-like symptoms. Without timely diagnosis and treatment, rheumatoid arthritis can lead to progressive joint damage, deformities, and persistent pain, resulting in a Juvenile rheumatoid arthritis, like adult RA, shared symptoms with many different types of arthritis. Joint destruction progresses soon after the onset Mar 12, 2024 · A doctor with specialized training in treating rheumatoid arthritis, called a rheumatologist, is the best person to make a correct diagnosis using medical history, a physical exam and lab tests. Apr 30, 2024 · Nursing Interventions and Actions. Mar 21, 2024 · Rheumatoid arthritis (RA) is a symmetric, inflammatory, peripheral polyarthritis of unknown etiology. Care and support are available, no matter where you live or what your specific needs are. Rheumatoid arthritis (RA) is a type of inflammatory arthritis. Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands Apr 7, 2022 · In most people, rheumatoid arthritis (RA) symptoms begin very subtly, and it may be many weeks or months before they become troublesome enough to seek medical attention. These may include joint pain, tenderness and swelling that affects the same joint or joints on both sides of your body (like both wrists or both knees); fatigue and fever. [1] Pain and stiffness often worsen following rest. Joint stiffness, often in the hands and feet, usually worse in the morning. Rheumatoid Arthritis (RA) Symptoms and Complications 855-695-4872 Outside of Maryland. Feb 6, 2024 · Rheumatoid arthritis (RA) is a chronic, erosive arthritis that requires early and aggressive treatment. Rheumatoid arthritis (RA) is a chronic (long-lasting) autoimmune disease that mostly affects joints. RA can Rheumatoid arthritis or RA is a form of inflammatory polyarthritis that can lead to joint destruction, deformity, and loss of function. Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints. You may feel fine for days or months and then experience a flare in pain and swelling in the joints. Oct 15, 2021 · Rheumatoid arthritis (RA) is an inflammatory form of arthritis that causes joint pain, swelling and damage. Listen to some words of wisdom that patients like you wish they had known when they were first diagnosed. 9 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. It usually presents as bilateral symmetric polyarthritis (synovitis) that affects the hands and feet (see the image below). Your family doctor may refer you to a rheumatologist, a doctor who is an arthritis expert. Smoking may also be linked to RA. It affects more than 1. This chronic inflammatory disorder can affect more than just your joints. It can occur at any age but most often develops between the ages of 25 and 50, and affects more women than men. Aug 29, 2023 · The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. Mar 15, 2023 · The diagnosis of rheumatoid arthritis relies mostly on the experience and judgment of the doctor, and is based on the "big picture" of symptoms, examination and test results. The X-rays done for RA diagnosis are typically of the May 2, 2018 · More women than men get rheumatoid arthritis. The inflammation can affect any of the important structures inside a joint, including the joint lining (synovium), bones, cartilage, or supporting tissues. Symptoms. The first thing your doctor will do is learn more about your medical history and symptoms. ” While rheumatoid arthritis can affect each person differently, there are common symptoms that affect nearly all patients, as well as lesser-known symptoms that can also provide clues to diagnosis. Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. Jan 25, 2023 · Areas of focus: Carpal tunnel surgery, Amputation, Arthroscopy, Finger ligament reconstruction, Forearm ligament reconstruction, Finger Show more areas of focus. RA Symptoms. Joint stif -ness is usually worse in the morning and may last 30 minutes or longer. The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). A new diagnosis can feel overwhelming and lonely, but you don’t have to navigate this journey alone. Rheumatoid arthritis is a disease in Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body. [1] It typically starts in small peripheral joints, is usually symmetric, and Rheumatoid arthritis ( RA) is a long-term autoimmune disorder that primarily affects joints. The joint stiffness found in active RA is usually worse in the morning and may last two hours or more, according to the American College of Rheumatology. Differential diagnosis. “The lab tests would point to likelihood of rheumatoid arthritis, as well as potentially rule out other possibilities on the differential diagnosis,” says Dr. What are the symptoms of rheumatoid arthritis? The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. Juvenile rheumatoid arthritis, also called juvenile idiopathic arthritis, is the most common type in kids. Swelling of the small joints, especially in the hands and feet, is the hallmark of the disease, but most joints in the body can become affected. stiffness, especially first thing in the morning or after sitting still for a long time. Nov 9, 2019 · Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. Like other types of arthritis, rheumatoid arthritis causes pain, swelling and stiffness in the joints. Common symptoms of arthritis include pain, stiffness, and swelling of the joint. Jun 12, 2022 · Diagnosing rheumatoid arthritis (RA) can take time. Joint stiffness that is usually worse in the mornings and after inactivity. 5 million Americans are living with RA. Medical history and symptoms. Jan 25, 2023 · The cause of RA is not known. Aug 8, 2019 · Numbness or tingling in the extremities. The disease often causes inflammation in the same areas on both sides of the body. anti-cyclic citrullinated peptide (Anti-CCP), and antinuclear antibody (ANA) are among the lab tests used. Rheumatoid arthritis sulit didiagnosis, karena gejalanya mirip dengan gejala pada penyakit lain, terutama jika masih pada tahap awal. Learn more Rheumatoid arthritis (RA) is a chronic (long-lasting) disease that mostly causes pain, swelling, stiffness, and loss of function in joints. The clinical spectrum of rheumatoid arthritis (RA) presentation is heterogeneous, with wide variation in age of onset, degree of joint involvement and severity. When untreated, joint damage and deformities can eventually lead to difficulty moving the hands, wrists, knees, and/or hips. Expected duration. 9 - other international versions of ICD-10 M05. Request an appointment. Learn about the symptoms, causes, diagnosis and treatment options for this chronic condition from Cleveland Clinic, a non-profit academic medical center. There’s a community of people who truly understand what you are going through, physically, mentally and emotionally. By using CKS, you agree to the licence set out in the CKS End User Rheumatoid arthritis symptoms. It is a chronic inflammatory disorder caused in many cases by the interaction between genes and environmental factors, including tobacco, that primarily involves synovial joints. These tests may include: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP ) blood tests detect and measure inflammation in your body. As nurses, our role in the care of patients with RA is paramount. Diagnosis. 3. Rheumatoid Arthritis. Getting a rheumatoid arthritis diagnosis can be scary, but you don’t have to feel alone during this time. Each person’s symptoms may vary, and may include: Pain May 4, 2023 · Rheumatoid arthritis (RA) is a type of autoimmune arthritis where your body’s immune system attacks its own tissue, including joints and internal organs, causing pain and swelling. Joints (typically the small joints of the limbs) become painful and have stiffness that Jun 14, 2023 · Rheumatoid Arthritis Initial Diagnosis. Blood vessel inflammation that causes damage to the nerves and organs, including skin. For example, early symptoms of RA include appetite loss and gastrointestinal (GI) symptoms like diarrhea, nausea, and vomiting. This guideline covers diagnosing and managing rheumatoid arthritis. The first symptoms people often notice are stiffness and pain or tenderness in their joints. 3 million people in the United States. joint swelling, warmth and redness. Along with pain, many people experience fatigue, loss of appetite and a low-grade fever. We would like to show you a description here but the site won’t allow us. Learn about joint pain, swelling and other symptoms, how to diagnose rheumatoid arthritis, and medications used to treat it. Other symptoms can include: tiredness and lack of energy – this can be known as fatigue. Rheumatoid arthritis diagnosis requires a proper medical evaluation and blood tests. a poor appetite (not feeling hungry) Oct 13, 2022 · Diagnosis rheumatoid arthritis perlu dicurigai pada pasien dengan poliartritis simetris persisten pada tangan dan kaki, keluhan sendi yang bersifat progresif, serta kesulitan melakukan aktivitas harian akibat keluhan yang dialami. 9 became effective on October 1, 2023. In RA, the immune system targets the lining of the joints, causing Rheumatoid arthritis is a disease that causes chronic abnormal inflammation, primarily affecting the joints. Symptoms may begin suddenly or slowly over time. Sep 10, 2023 · Some patients with crystal-induced arthritis, especially calcium pyrophosphate arthritis, may meet criteria for rheumatoid arthritis; however, synovial fluid examination should clarify the diagnosis. Apr 14, 2024 · Rheumatoid arthritis is an autoimmune disorder affecting the joints, causing pain and swelling. RA usually starts in the small joints of the hands and feet but it can also affect other Rheumatoid arthritis is a chronic autoimmune disease in which the body’s immune system attacks healthy tissue, primarily the tissue lining the joints. However, patients with JRA usually share some common side effects. Rheumatoid arthritis (RA) is an inflammatory, autoimmune condition that affects not only joints but also organs, including eyes. This article aims to shed light on the crucial nursing interventions, patient education, and holistic support May 15, 2023 · Rheumatoid arthritis (RA) is a chronic condition. A flare can be difficult to predict, but with treatment it's possible to decrease the number of flares and Dec 6, 2023 · Normal body temperature is between 97 and 99 degrees F, and a low-grade fever ranges from 100. Sep 19, 2023 · Part of diagnosing rheumatoid arthritis (RA) involves ruling out other conditions that mimic RA, such as fibromyalgia, Lyme disease, and osteoarthritis. Early diagnosis is crucial because it Oct 25, 2023 · Rheumatoid arthritis (RA) is a difficult disease for healthcare providers to diagnose, especially in its early stages, because the signs and symptoms are similar to those of many other conditions. In general, patients will have pain and stiffness in The onset of rheumatoid arthritis is often gradual, and not every person experiences the same symptoms. Persistent inflammation over time can lead to issues with mobility, fatigue, illness, and joint deformity. Therapeutic interventions and nursing actions for patients with rheumatoid arthritis (RA) may include: 1. Learn how to diagnose RA with medical history, physical examination, blood tests and imaging tests. Treatments can include medications, ongoing care from a doctor, and surgery. Juvenile idiopathic arthritis (JIA) is a form of arthritis in children. Oleh sebab itu, dokter akan melakukan beberapa pemeriksaan untuk memastikan diagnosis. provides the latest insights into the epidemiology, genetics Symptoms. Jan 6, 2021 · Rheumatoid arthritis (RA) is the most common inflammatory arthritis. Lung inflammation that causes shortness of breath. It typically leads to joint destruction through the erosion of cartilage and bone. Nov 20, 2023 · The classic signs and symptoms of rheumatoid arthritis include pain, swelling, and stiffness of several joints. Learn how doctors diagnose rheumatoid arthritis based on symptoms, family and personal medical history, blood tests, imaging scans and other factors. These tests primarily look for bone damage in the patient’s joints caused by the inflammation associated with RA. May 2, 2019 · The pattern of symptoms helps establish the diagnosis. — Your joints begin to swell or turn red on a regular basis even when you’re not engaged in heavily physical activities. Pain, swelling, and tenderness in the joints. Approximately 1. If you notice your child has any of the… Rheumatoid arthritis is a chronic inflammatory disease of the joints. Sep 13, 2023 · Symptoms of juvenile arthritis may include: Joint stiffness, especially in the morning. Learn more about diagnosing RA Symptoms and Effects. Children as young as two years old can be diagnosed with juvenile rheumatoid arthritis. But many Apr 1, 2018 · Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis, with a lifetime prevalence of up to 1% worldwide. The normal role of your body’s immune system is to fight off infections to keep you healthy. Light sensitivity and impaired vision. RA mainly attacks the joints, usually many joints at once. 03. In order to be diagnosed with juvenile rheumatoid arthritis, a child must have started showing symptoms before the age of 16 or 17 years old. There may be periods where symptoms become worse, known as flare-ups or flares. The presence of crystals makes rheumatoid arthritis unlikely, although calcium pyrophosphate crystal disease and rheumatoid arthritis may coexist Rheumatoid Arthritis Symptoms. In addition to the joints, other manifestations of the disease Rheumatoid arthritis (RA) imaging tests are used to look for signs of RA and to monitor the disease’s progression. Penyakit ini lebih sering terjadi pada wanita, terutama yang berusia 30–50 tahun. Juvenile rheumatoid arthritis is difficult to diagnose because many children do not complain of the ICD 10 code for Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement. The most common signs and symptoms are pain, swelling, and stiffness of the joints. 1 It has a significant impact on occupational and daily activities Dec 11, 2023 · Rheumatoid factor (RF). Selain menyerang sendi, rheumatoid arthritis juga bisa menyerang organ lain, seperti kulit, pembuluh darah, paru-paru, mata, dan jantung. Arthritis causes joint swelling (inflammation) and joint stiffness. RA impacts your smaller joints first, like the ones in your fingers and toes. Joints (typically the small joints of the limbs) become painful and have stiffness that Update on the diagnosis and management of early rheumatoid arthritis. It often starts in middle age and is most common in older people. The symptoms of it are similar to RA in adults. Rheumatoid arthritis usually affects small joints in the hands and feet. Mar 5, 2024 · Juvenile rheumatoid arthritis symptoms. RA occurs when the immune system, which normally helps protect the body from infection and disease, attacks its own tissues. Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system attacks its own tissue. RA symptoms. Anaemia means the blood is unable to carry enough oxygen because of a lack of blood Experts agree that the most common initial symptoms are as follows: — You begin to experience a general feeling of pain or stiffness in your joints. It aims to improve quality of life by ensuring that people with rheumatoid arthritis have the right treatment to slow the progression of their condition and control their symptoms. To help prevent RA from progressing to joint damage, the American College of Rheumatology has developed specific, comprehensive criteria to guide doctors in diagnosing RA in earlier stages of the disease. What to look for It can take years for many kids to receive a proper JRA diagnosis. With this information, a doctor can diagnose a patient. It can also damage your skin, eyes, lungs, heart and blood vessels. Any joint lined by a synovial membrane may be affected, however, and extra-articular involvement of organs such as the skin, heart Rheumatoid arthritis (RA) is an autoimmune disease that causes pain and swelling of the joints. Sep 7, 2020 · Rheumatoid arthritis is an autoimmune inflammatory disease primarily characterized by synovitis which is accompanied by extra-articular organ involvement, such as interstitial pneumonia, in addition to clinical symptoms including pain, swelling, stiffness of multiple joints, fever, and malaise. — These symptoms extend to four or more of your joints, including Oct 25, 2021 · However, multiple blood tests can indicate rheumatoid arthritis is the likely cause of your symptoms. Investigations for suspected RA. Like other forms of arthritis, a diagnosis is based largely on the findings from a medical exam and your symptoms. Neogi. If left without treatment, RA can result in joint damage and functional disability. Osteoarthritis causes cartilage — the hard, slippery tissue that covers the ends of bones where they form a joint — to break down. Aug 20, 2021 · Rheumatoid arthritis (RA) usually takes time to diagnose. People should also have rapid access to specialist care if their condition suddenly worsens. Rheumatoid arthritis, unspecified. Small joints in the hands and feet are involved most often, although larger joints (such as the shoulders, hips, and knees) may become involved later in Jul 11, 2018 · Next. Early and aggressive treatment with disease-modifying antirheumatic drugs (DMARDs), potentially combined with a Feb 8, 2018 · Rheumatoid arthritis is a chronic, inflammatory, autoimmune disease that primarily affects the joints. Sep 13, 2023 · Learn about the symptoms, tests, and treatments for RA, a chronic autoimmune disease that affects your joints. Learn about the symptoms of RA and how to deal with joint stiffness, rheumatoid nodules, and more. Fever occasionally occurs and is almost always low grade (37° to 38°C; 99° to 100°F). Imaging tests include X-rays, MRIs, ultrasounds, and CT scans. Diagnosed clinically. The heart, lungs, eyes, and circulatory system can also become affected, causing other symptoms and increasing the risk of M05. Identifying the symptoms of rheumatoid arthritis is crucial for early diagnosis and effective management. Rheumatoid arthritis, also called RA, is an autoimmune disease that causes inflammation, pain and swelling in the joints. Rheumatoid arthritis is a joint inflammation disease which begins slowly and progresses over time. Dec 13, 2023 · X-Ray. 9 may differ. The condition may affect one, a few, or many joints throughout Jun 30, 2023 · Blood tests for rheumatoid arthritis include one for antibodies called rheumatoid factors With early diagnosis, most types of arthritis can be managed and the pain and disability minimized. Here are some of the other, mistakable symptoms of rheumatoid arthritis: Eye dryness and pain. X-rays used to be the most common form of imaging ordered, but they…. Update on the diagnosis and management of early rheumatoid arthritis. RA can occur at any age, but is more common in middle age. Infection, genes, and hormone changes may be linked to the disease. There is no single test that can definitively diagnose RA. xz xe bm ni la sm zd ho rd qt