Do Normal Blood Test Results Rule out Rheumatic Diseases?

A Look at Blood Markers Indicative of Rheumatoid Arthritis

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Is it possible to have rheumatoid arthritis (or other rheumatic diseases) and have blood work that is within a normal range of inflammation markers? How much of the diagnosis is based on the blood tests for inflammation?

Do Normal Blood Test Results Rule Out Rheumatic Diseases?

Most patients with rheumatoid arthritis (RA) have some marker of the disease in the blood. This might include:

On the other hand, occasionally a patient with RA may have active disease and all these tests are normal. In general, those patients without these abnormalities in the blood are less likely to develop joint damage. Almost all patients with lupus have the presence of the antinuclear antibodies (ANA) or if negative, an SSA antibody or antiphospholipid antibodies (associated with an increased risk of thromboses such as a blood clot or stroke or miscarriage). Once again, there are patients, although rare, who have lupus despite these negative tests. Most Sjogren's syndrome patients will typically exhibit an elevated ESR or have a positive ANA, RF, SSA or SSB antibody in their blood.

It is important to remember that while blood tests are helpful in confirming a diagnosis and assessment of disease activity, it is more important to diagnose and treat based on the patient's clinical presentation.

How Is Rheumatoid Arthritis Diagnosed?

Rheumatoid arthritis can be difficult to diagnose because the signs of this illness can be subtle and nonspecific. For example, joint stiffness and achy joints--specifically, after waking up--can be attributed to various types of disease.

Ultimately, a diagnosis of rheumatoid arthritis is best made by a rheumatologist.

A rheumatologist is an internist (or pediatrician) who receives further training in musculoskeletal and autoimmune disease. Typically, a person will make an appointment with her primary care physician who will then suspect arthritides and refer the patient to a rheumatologist for further evaluation. Of note, if you suspect that you may have rheumatoid arthritis, it's important to alert your primary care physician to these concerns.

A diagnosis of rheumatoid arthritis is based on several findings including the following:

  • anti-CCP (a specific type of antibody)
  • anemia
  • elevated ESR (a non-specific test for inflammation)
  • rheumatoid factor (eventually present in 80 percent of people with rheumatoid arthritis)
  • diagnostic tests including x-ray, MRI, and ultrasound
  • warmth, swelling, and pain of the joints

Advice Concerning Rheumatoid Arthritis

If you or a loved one suspect rheumatoid arthritis, it's imperative that you receive medical attention, diagnosis, and treatment. Rheumatoid arthritis not only results in more immediate disability and compromise of quality of life but is also linked to other serious illnesses such as heart disease.

A diagnosis of rheumatoid arthritis is serious and life-changing.

Often, people who are diagnosed with rheumatoid arthritis feel isolated and sad. Rest assured, however, that with proper treatment and other interventions aimed at increasing muscle strength (like walking and other low-impact exercises), many people with rheumatoid arthritis feel much better over time.


Answer provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association.