When patients present to the rheumatologist they often have not yet received a definitive diagnosis.

Despite all the high tech tools available today, the most important part of evaluating the patient remains a careful history and physical examination (see Part 3). Helpful diagnostic laboratory tests include the rheumatoid factor, erythrocyte sedimentation test (ESR), C-reactive protein (CRP), and more recently a new test called the anti cyclic citrullinated antibody (anti-CCP). One note of caution: the presence of a positive rheumatoid factor doesn't necessarily indicate the diagnosis of rheumatoid arthrits. Multiple other conditions can cause rheumatoid factor positivity. By the same token, roughly 20 % of patients with rheumatoid arthritis are rheumatoid factror negative.

Imaging procedures such as magnetic resonance imaging and ultrasound are helpful. Diagnostic x-rays are of limited use because significant damage can occur long before it shows up on x-ray.

The goals of management include: aggressive and early treatment, reduction of signs and symptoms, prevention of deformities, maintenance of joint function, control of co-morbidities (other associated disease such as hypertension, diabetes, etc., a patient might have), and possibly... cure. While this last option is still not quite achievable just yet , it is becoming more of a possibility.

In addition to medications, treatment of RA includes diet, exercise, joint protection, and occasionally joint surgery.

The approach to RA treatment has changed dramatically in the last 5 years.