Mysterious Symptoms and then…Diagnosis: Still’s Disease

For many months, Bethany Pautsch’ symptoms were a mystery to the doctors she was seeing in Chicago. When she was told she would need a hip replacement without knowing the cause of the symptoms and deterioration of her joints, she came to Mayo Clinic, where a doctor quickly diagnosed her as having: Still’s Disease. Listen to her explain how this diagnosis and subsequent treatment have changed her life…


Rheumatoid Factor (RF) Test: MedlinePlus Lab Test Information


What is a rheumatoid factor (RF) test?

A rheumatoid factor (RF) test measures the amount of rheumatoid factor (RF) in your blood. Rheumatoid factors are proteins produced by the immune system. Normally, the immune system attacks disease-causing substances like viruses and bacteria. Rheumatoid factors attack healthy joints, glands, or other normal cells by mistake.

An RF test is most often used to help diagnose rheumatoid arthritis. Rheumatoid arthritis is a type of autoimmune disorder that causes pain, swelling, and stiffness of the joints. Rheumatoid factors may also be a sign of other autoimmune disorders, such as juvenile arthritis, certain infections, and some types of cancer.

Other names: RF Blood Test

What is it used for?

An RF test is used to help diagnose rheumatoid arthritis or other autoimmune disorders.

Why do I need an RF test?

You may need an RF test if you have symptoms of rheumatoid arthritis. These include:

  • Joint pain
  • Joint stiffness, especially in the morning
  • Joint swelling
  • Fatigue
  • Low-grade fever

What happens during an RF test?

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for the test?

You don’t need any special preparations for an RF test.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

If rheumatoid factor is found in your blood, it may indicate:

About 20 percent of people with rheumatoid arthritis have little or no rheumatoid factor in their blood. So even if your results were normal, your health care provider may order more tests to confirm or rule out a diagnosis.

If your results were not normal, it doesn’t necessarily mean you have a medical condition needing treatment. Some healthy people have rheumatoid factor in their blood, but it’s not clear why.

Is there anything else I need to know about an RF test?

An RF test is not used to diagnose osteoarthritis. Although rheumatoid arthritis and osteoarthritis both affect the joints, they are very different diseases. Rheumatoid arthritis is an autoimmune disease that affects people at any age, but usually occurs between the ages of 40 and 60. It affects more women than men. Symptoms may come and go and vary in severity. Osteoarthritis is not an autoimmune disease. It is caused by the wear and tear of joints over time and usually affects adults over the age of 65.

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Treating Rheumatoid Arthritis: Search for a Cure


NIH studies look for new medications and improved outcomes

Rheumatoid Arthritis (RA) is a tricky disease.

No one knows what causes it, but while there isn’t yet a cure for the autoimmune disease, it can be treated. Arthritis is an extremely common problem but not all forms of arthritis are alike.

Just as symptoms of RA can vary, medical treatments can vary, but the important thing to know is that over the last 20 years the treatment of RA has changed dramatically with the approval of many new, highly effective drugs.

These can help slow or stop joint damage, minimize disability, and reduce inflammation, pain and swelling. Lowering, stress, eating a healthy diet, quitting smoking, and getting enough rest are all suggested lifestyle changes.

Some medicines are taken by mouth, while others require regular injections; these drugs are highly effective, but do have side effects. Thus, it’s essential to get a proper diagnosis from a doctor who specializes in rheumatic diseases, understands all the different causes of arthritis—in adults and children—and has experience with the new drugs, advises John O’Shea, M.D., scientific director at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

“RA and other autoimmune diseases don’t just affect the joints, they cause inflammation throughout your body,” Dr. O’Shea says.

The main goal in treating RA is to reduce inflammation and pain, stop more joint damage, and to be able to function normally.

“We now have better treatment therapies to keep you safe, as well as clinical studies that specifically look at inflammation,” Dr. O’Shea adds. The RA drug tofacitinib, approved for the treatment of RA in 2012, targets a protein that was discovered in the early 1990s by O’Shea and his colleagues.

Dr. O’Shea and his team at NIAMS are studying the molecular and genetic basis of rheumatoid arthritis and other inflammatory diseases in an effort to identify potential strategies for future therapies.

Researchers are also studying the natural history of the disease in children and adults to understand more fully how RA progresses and impacts people’s lives.

In addition, NIAMS researchers are collaborating with investigators outside of NIH to explore whether people with RA who are in remission (no symptoms of the disease) while taking TNF inhibitors are at risk of having symptoms come back if they stop taking the medicine.

Another study funded by NIAMS focuses on RA patients with inflammation in the blood vessels and heart tissue, which can eventually lead to heart disease.

“People who have rheumatoid arthritis have a 50 percent increase in chance of experiencing a stroke or heart failure,” says Joan Bathon, M.D., chief of the division of rheumatology at Columbia University Medical Center in New York.

Known as the TARGET study, the clinical trial aims to see if treatment of arthritis in individuals with RA will also reduce inflammation in blood vessels. Inflammation in blood vessels is believed to be an early predictor of atherosclerosis (hardening of the arteries) which leads to heart attacks and strokes. If RA medications reduce inflammation in blood vessels, this may reduce future chances of heart attacks and strokes. “We want to aggressively treat rheumatoid arthritis, to see if it will help the heart,” Dr. Bathon says.

Joining a clinical study such as the TARGET study will help researchers find a cure more quickly. There are 30 sites in the U.S. focusing on the TARGET study, with more to come soon.

“We have a lot of treatments, but none of our treatments cure the disease,” Dr. Bathon says. “In lieu of a cure is prevention of related complications from the disease. RA is treatable. We’re focusing on outcomes right now and getting people with RA back on track.”

The bottom line: If you have symptoms of rheumatoid arthritis, early diagnosis is essential. It is critical to get aggressive treatment as early as possible to help slow RA and help prevent permanent joint damage.

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Matt Iseman: Rheumatoid Arthritis Warrior


Emmy-winning ‘American Ninja Warrior’ host opens up about health, career, and NIH research

Photo: courtesy of NBC.

Matt Iseman was trained as a doctor, but he is known to many as a comic, first winner of the “New Celebrity Apprentice,” and host of the hit TV show “American Ninja Warrior.” He is also one of millions of Americans living with arthritis and has been an advocate for more research into the condition. He spoke with NIH MedlinePlus magazine to talk about his experience and what drives him to success.

Tell us about your experience with rheumatoid arthritis.

I was diagnosed Christmas of 2002. When I was told I had rheumatoid arthritis (RA), the first thought I had was relief. People are always shocked when they hear that. But it had been 18 months that I had been having symptoms—18 months when my body and my life were falling apart.

What was it like at first?

I had just turned 30 and my symptoms started with pain in my right index finger and then spread to my feet, back, and neck. I was always exhausted and often sleeping up to 14 hours a day. I had been an athlete all my life, but couldn’t work out at all and eventually gained 55 pounds. I saw a range of doctors, but no one could tell me what was wrong.

When I was finally told I had RA, I was relieved because I knew there was something I could do about it.

I’m walking proof of the importance of research like that done by NIH.

What’s the good news?

The good news is when I started treatment (with a biologic medicine that helps reduce inflammation), it gave me my life back.

That is why I have been a passionate advocate, working with groups like the Arthritis Foundation to let others know that there is hope. Despite the fact that I am a doctor and understood the disease, I didn’t know anyone who had it. Many who are newly diagnosed go online and see the worst-case scenario.

I want them to see me, someone who won “Celebrity Apprentice,” who hosts “American Ninja Warrior,” and travels the country doing stand-up comedy. I love sharing my story. There is hope. This is a disease you can lead a full life with.

What do you do to keep up your health and energy?

I used to play basketball, but I haven’t played basketball or run since I was diagnosed. I like to tell people that whatever you are dealing with, don’t focus on what you can’t do, focus on what you can do. You will be amazed at what you can accomplish.

I have discovered yoga and pilates. They are terrific for building strength and flexibility. If you are dealing with RA, the saying goes “motion is lotion.” The more you move the better you feel and the better your vitality.

Laughter has always been key for me, particularly when I was down before I was diagnosed. Stand-up comedy really saved my life at that point. No matter how bad I felt, I did stand-up comedy, laughing and making others laugh. Taking care of yourself physically and emotionally is key. And laughter is such a great tool.

What about the importance of having a strong support community?

No one does it alone. We talk about that on “American Ninja Warrior” and I talk about arthritis.

When you are newly diagnosed, your doctor, your nurse, and your family are going to talk to you. But it is also important to talk to someone who is going through or has been through what you are. Join a group to share stories and tips about living with RA.

NIH supports a great deal of research aimed at improving treatments for arthritis. Would you speak to the importance of this research?

I’m it. I’m walking proof of the importance of research like that done by NIH. The medication I’m on was discovered just four years before I was diagnosed.

We would not have advancements like this without the research supported by NIH. We need to make sure that researchers have the funding to develop even better treatments and one day find a cure.

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Know the Difference: Rheumatoid Arthritis or Osteoarthritis?


Rheumatoid Arthritis


Rheumatoid Arthritis is an autoimmune disease, a result of the immune system attacking the tissues that line the body’s joints. This causes pain, swelling, and stiffness in the joints and the pain is often symmetrical. It is more common in women and in those who are middle aged, but it can happen to anyone.



Osteoarthritis happens over time. It is the most common form of arthritis, and it usually occurs in older people. The protective cartilage on the ends of your bones wear down as you age, making it difficult to move. It usually affects one side of the body. Osteoarthritis can damage any joint in your body, though it most commonly affects joints in your hands, knees, hips, and spine.

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Rheumatoid Arthritis: Understanding a Difficult Joint Disease


When you hear about someone who has arthritis, you might think of an older person with pain or stiffness in his or her joints. But that’s not always the case.

There are many types of arthritis and millions of people in the U.S. have some form of it. One type of arthritis that affects more than 1.5 million people in the U.S. is rheumatoid arthritis.

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease, which means the body’s immune system mistakenly attacks the tissues that line your joints instead of fighting infections.

RA causes pain, swelling, and stiffness in your joints. It usually affects your wrists, hands, and knees, preventing them from working properly. While RA is more common in women age 30 or older, RA can affect all people.

RA is different from the more common osteoarthritis, which is the arthritis that many older people develop over time. No one knows what causes RA. While there is no cure, it can be treated.

What to look for

Symptoms of RA range from mild to severe. Sometimes RA affects one joint at a time, but more typically it presents as pain, warmth, and swelling in the joints on both sides of the body at the same time or on alternating sides.

It can also affect body parts that are not joints, including your eyes, mouth, heart, and lungs. Symptoms can last for only a short time or they can come and go.

It’s important to recognize the signs of RA and see your health care provider as soon as possible to get a proper diagnosis. Your provider will use tests  to help diagnose you and then refer you to a rheumatologist, who focuses on autoimmune illnesses–many of which target the musculoskeletal tissues. You and your rheumatologist can determine the treatment that is best for you.

Symptoms of RA include some or all of the following:

  • Swollen, tender, or warm joints
  • Symmetric swollen joints (on both sides of the body), such as in both your right and left wrists
  • Swollen joints in the wrist and finger joints closest to the hand
  • Other swollen joints such as the neck, shoulders, elbows, hips, knees, ankles, and feet
  • Feeling tired and having low energy
  • Fevers
  • Pain and stiffness that lasts for more than 30 minutes in the morning or after a long rest
  • Symptoms that last for many years

SOURCE: National Institute of Arthritis and Musculoskeletal and Skin Diseases: Rheumatoid Arthritis Opens new window

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