Welcome to From Practitioner to Patient, a column by Stefanie Remson about living with arthritis. Stefanie is both a nurse practitioner and a patient living with RA. She’s here to share what she’s learned from her own experiences as a patient and to demystify the medical side of navigating arthritis through her knowledge as a nurse practitioner.
Regular medical appointments that include a physical exam can play a big part in diagnosing and managing rheumatoid arthritis (RA).
Joint swelling, deformities, tenderness, warmth, and limited range of motion are all traits of RA that can be confirmed by a physical exam.
A physical exam is a routine test conducted by a healthcare professional. It’s used to check your overall health by inspecting, feeling, or listening to different parts of your body. A physical exam can also check for a particular issue or health condition, such as RA.
Historically, a physical exam has been the most important part of a medical appointment. But in recent years, with notable improvements in technology, the physical exam has become less important. The increased use of telehealth services has meant fewer physical exams have been conducted — and health outcomes have actually improved, according to this 2021 study.
But there is still data that supports the important role of thorough physical exams since they can minimize diagnostic errors.
In 2012, a survey distributed to U.S. physicians reported that a physical exam was still considered one of the most important factors for the diagnosis and management of RA. A thorough physical exam can also help avoid expensive and invasive testing.
A physical exam, in addition to a thorough history, can help a healthcare professional narrow down or even establish an accurate rheumatological diagnosis. It’s another tool in their tool belt to provide you with the best care.
You might have a physical exam for a number of different reasons, and what happens varies between healthcare professionals and patient needs.
Some doctors may evaluate more or less each time you’re seen, too. In general, the four following areas will be assessed:
A physical exam often starts with you walking into the office and back to the exam room. Your medical team will evaluate the way you walk and your ability to be mobile at this time.
This also gives your doctor an opportunity to evaluate if you appear fatigued or well-rested.
Next, your vital signs may be taken, including temperature, blood pressure, heart rate, respiration, and oxygen saturation. These are important because people living with RA might run low-grade fevers or have other vital signs that are affected.
You can expect a thorough joint evaluation, which includes touching, feeling, squeezing, and bending the small joints of your hands and feet. Your doctor is looking for redness, heat, pain, swelling, and changes since the last time they evaluated these same joints.
You may be asked if certain movements hurt, and you may be asked to move in specific ways.
Redness, heat, pain, and swelling can indicate a joint affected by RA. It can also mean other things, such as injury or infection, and this is something your rheumatologist will determine. Further testing, including bloodwork, sending the fluid around the joint to the lab, and radiology studies (X-ray, MRI, or ultrasound) may be needed to further evaluate these findings.
They may also look for deformity without redness and heat, which may mean permanent damage in joints that have been affected by RA for many years or decades.
If you have new redness, heat, pain, swelling, or a new deformity in a joint, the physical exam is a good time to point this out for evaluation.
RA can affect other systems besides the musculoskeletal system. The physical exam may include a comprehensive skin evaluation, listening to your heart and lungs, pushing on your abdomen, and looking in your ears, eyes, and mouth.
For example, rheumatoid nodules can be seen on a physical exam, which can be an important clue for diagnosing RA. These findings may help to inform a plan of care, possibly eliminating medication options or determining how frequently you may require appointments.
During your physical exam and when determining a diagnosis, your doctor may have the 2010 rheumatoid arthritis classification criteria in mind. Criteria like this are developed for eligibility in clinical trials for anyone interested in participating. They help to create a similar study population for a trial to go ahead.
In this criteria, the classification of “definite RA” depends on confirming factors that focus on the joints. A physical exam is really important to assess someone’s diagnosis as it can identify symptoms beyond the joints that the criteria does not account for.
A physical exam is an important and routine part of healthcare. It’s a crucial way to assess the current state of your joints and identify any other symptoms of concern for RA.
Medically reviewed on June 26, 2023
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