For a lot of people, stiff hands in the morning is one of the most common complaints they have when it comes to rheumatoid arthritis.
Especially when they think it goes away with time—and it doesn’t—that’s when most start wondering: why isn’t my hand pain going away?
Especially with rheumatoid arthritis, it’s not something that’s diagnosed on a single test.
It requires data from three ends: what your joints are doing, what your bloods show, and what imaging finds inside the joint.
Here’s all you need to know about rheumatoid arthritis, the diagnosis, how an ultrasound helps and how to book one in London.
What is rheumatoid arthritis, and how is it different from osteoarthritis?
Osteoarthritis is different. It’s wear and tear in the cartilage that builds up over years of use, and it isn’t driven by the immune system at all.
Rheumatoid arthritis can start at any age and often affects smaller joints like the hands, wrists and feet first, with morning stiffness that typically lasts more than an hour. Osteoarthritis is more common in middle-aged and older adults, tends to affect weight-bearing joints like the knees, hips and spine, and morning stiffness usually improves within 20 to 30 minutes.
And here’s the interesting bit: the treatments have nothing in common. Osteoarthritis is managed with exercise, weight management and pain relief. Rheumatoid arthritis needs medication that calms the immune response, started as early as possible, because the joint damage it causes doesn’t reverse.
What are the early signs to look out for?
Early rheumatoid arthritis is easy to dismiss, because it starts small and it comes and goes.
The pattern clinicians look for is joint pain and swelling that has lasted more than six weeks, affects several joints rather than one, involves the small joints of the hands or feet, and comes with morning stiffness lasting longer than 45 minutes.
Symmetry is a useful clue. If both index knuckles are sore, or both wrists, that points more strongly towards an inflammatory cause than a single painful joint does.
How is rheumatoid arthritis diagnosed?
Here’s the thing: there’s no single test that gives you a yes or no answer. Diagnosis comes from putting three pieces together.
Clinical examination
A clinician checks which joints are swollen and tender, how many are involved, whether the pattern is symmetrical, and how long stiffness lasts. This is the backbone of the diagnosis, and no test replaces it.
Blood tests
These look for inflammation and for the antibodies associated with rheumatoid arthritis. The NHS puts the limitation plainly: no blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition.
Imaging
X-rays show damage that has already happened. Ultrasound shows inflammation that is happening now, which is why it has become the imaging test used earliest in the pathway.
| Blood test | What it’s looking for |
|---|---|
| Rheumatoid factor (RF) | An antibody linked to RA. More than half of all people with rheumatoid arthritis have high levels at the start, but about 1 in 20 people without RA also test positive. |
| Anti-CCP antibodies | More specific to RA. People testing positive are very likely to develop rheumatoid arthritis, but not everybody with RA has this antibody. |
| CRP and ESR | General markers of inflammation anywhere in the body. |
| Full blood count | Checks for anaemia, which often accompanies RA, and helps exclude other causes. |
| ANA | Screens for other autoimmune conditions that can look similar. |
| Uric acid | Checks for gout, which can mimic inflammatory arthritis. |
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Our rheumatology screening brings all three together
The blood panel, joint ultrasound, and a GP consultation that reads the results side by side rather than in isolation.
Book Rheumatology Screening