Doctors diagnose arthritis by asking questions about a person’s symptoms and examining their body. They also use tests such as blood tests, X-rays, CT scans (computerised tomography), ultrasound scans or MRI (magnetic resonance imaging) scans.
Sometimes specialist tests are needed to help diagnose rarer forms of arthritis, such as systemic-onset JIA, which can affect internal organs such as the heart. A doctor who suspects systemic arthritis may use a chest X-ray or heart scan, called an ‘echocardiogram’, to see if the person’s heart is inflamed.
The people we spoke to mentioned different kinds of tests. Some said they were diagnosed after a blood test and a physical examination by a rheumatologist. Others described having lots of tests before being diagnosed. These tests were ordered by GPs, Accident and Emergency (A&E) doctors or consultants such as rheumatologists or orthopaedic specialists.
Blood tests can be used to detect some types of arthritis, such as rheumatoid arthritis. Doctors look for things like antibodies and inflammation markers in the blood. Blood tests can also help doctors to find out whether the symptoms are caused by a different condition.
Having blood tests can be difficult for people who are afraid of needles. Some people we spoke to were nervous after having a “bad experience” during a blood test, such as feeling faint and dizzy. Because people with arthritis have regular blood tests they may get used to them over time, and some people never had a problem with blood tests at all.
X-rays are sometimes used to see if something other than arthritis is causing people’s symptoms. Before Kerrie was diagnosed she had pain and swelling in her fingers and thought that they were broken. She was given an X-ray but the doctor saw no damage or broken bones. When Jenna had an X-ray she was asked to put her hand on a board and keep still.
It is important that healthcare staff explain what the different tests are for, and for the people we talked to most did, but occasionally people would have liked more information.
Ultrasound scans and MRI scans are also used to look inside and around people’s joints. Bone scans can be used to see if bones are becoming brittle (hard but easily broken) or crumbling. People sit or lie down on a bed while a scanner moves across their body.
Ultrasound and MRI scans can be used to look for signs of inflammation. Ultrasound scans are commonly used on pregnant women to see how their baby is growing but they can also be used to look at other parts of the body. The person doing the scan moves a small scanner across the area that he or she needs to look at. When they are used on people with arthritis they help doctors look for signs of synovitis (inflammation of the tissue around synovial joints).
An MRI scanner is a lot bigger than other types of scanners. Bradley says that an MRI scanner looks like a “giant Polo” that people lie inside. People are asked to keep still while the scan takes place. They can listen to music (Leigh said the music was “a bit rubbish”!). They can also watch TV when they are inside the scanner (Jenna watched The Simpsons). Some people find the scan relaxing. Others do not like being in the small space – they find it claustrophobic. MRI scans can also be quite noisy, making a kind of banging sound. This is caused by vibrations as electricity is passed through coils of metal wire inside the scanner to create a magnetic field. When people are inside the scanner they can also press a buzzer if they want to speak to somebody or come out.
If people have fluid around their joints they may have the fluid drained (‘aspirated’) and tested to see if there is an infection. Leigh found his hip aspiration very painful. When Tom had his knee aspirated it felt like his joint pressure was being released.
Some of the people we spoke to had difficulties remembering what certain tests were like. This was often because they were too young to remember or because they blocked out that part of their life.
Others felt well informed about why they were being tested and what to expect. This was because medical staff explained what was going on. This helped people relax during the tests. When people did not know what was going on they became frustrated or frightened.
People with arthritis will carry on having tests after they are diagnosed. These tests help doctors monitor the arthritis and to make sure that the medications are not causing unwanted side effects (see Clinics and monitoring arthritis).