Can You Make a Fist?

Rheumatoid arthritis (RA) can be a tricky disease to diagnose – but there might be a new tool for clinicians to rely on: fist strength. More on that later, but first, let’s take a look at why diagnosis is so tough.

RA tends to mimic other inflammatory conditions, especially in the early stages. To add to the difficulty: there is not just one single test that can confirm RA. Rather, to make a diagnosis, there are several factors that each support (or not) an RA diagnosis, including:

  • Personal medical history
  • Family medical history
  • Symptoms
  • Physical exam
  • Blood tests
  • Imaging tests

All of the diagnostic criteria can take time to bring clarity about the presence of RA. Yet, it’s also well-known that patient outcomes are better when treatment starts early (generally with the use of disease-modifying anti-rheumatic drugs). In fact, research shows that most people with RA will develop at least some amount of joint damage – but more alarming than that, it generally happens in the first two years of disease onset.

All of this is to point out that early diagnosis and treatment is very important. The earliest symptoms of RA can include:

  • Joint pain, swelling, and/or stiffness, especially in small joints (e.g., wrists, hands, or feet) lasting 6+ weeks
  • Morning stiffness
  • Fatigue
  • Loss of appetite
  • Symmetrical symptoms affecting both sides of the body
  • Rheumatoid nodules developing under the skin

Now, let’s circle back to the “fist strength” issue. Recently, a group of researchers determined that fist strength (as measured by a patient squeezing the assessor’s fingers) and incomplete fist closure can serve as a predictor of RA. The incomplete fist closure is a sign of imminent RA and considering that it is nearly a free test (as compared to, say, an MRI), it can be a simple way to add more information to the diagnostic picture.

Of course, once a patient is diagnosed with RA, they can rely on BioPlus to assist in starting treatment and to answer any treatment questions. We’re here to help.


Wouters F, van der Giesen FJ, Matthijssen XME, et al. Difficulties making a fist in clinically suspect arthralgia: an easy applicable phenomenon predictive for RA that is related to flexor tenosynovitis [published online May 2, 2019]. Ann Rheum Dis doi:10.1136/annrheumdis-2019-215402