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Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the second most common form of arthritis, the inflammation or swelling of one or more joints. More than 100 conditions affect the joints, tissues around the joint, and other connective tissues. Learn more about osteoarthritis and other conditions. 

 

RA is an autoimmune and inflammatory disease - the immune system attacks healthy cells in the body, resulting in inflammation. RA is most common in the hands, wrists, and knees.  It usually affects many joints at once. The lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness, and deformity. 

 

Approximately 40% of people with RA also experience the condition in other areas including the skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissues and bone marrow. 

Risk Factors

Several genetic and environmental risk factors contribute to RA. 

  • Age increases the chance of developing RA, which is highest among adults in their sixties.

  • Smoking increases the risk and affects the disease severity. 

  • Women are two to three times more likely to develop RA than men. 

  • Women who have never given birth may have a greater risk. 

  • Family history of RA and inherited traits, such as those born with the gene HLA  (human leukocyte antigen)  

  • Excess weight and obesity 

  • Early Life Exposures, such as mothers who smoked, may increase the risk.

 

Symptoms

RA signs and symptoms can vary in severity. Early RA tends to affect smaller joints first, particularly the finger and toe joints.  As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips, and shoulders. In most cases, symptoms occur in the same joints on both sides.  There are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.  Signs and symptoms of RA may include:

  • Pain or aching in more than one joint

  • Stiffness in more than one joint

  • Tenderness and swelling in more than one joint

  • The same symptoms on both sides of the body (such as in both hands or both knees)

  • Weight loss and loss of appetite

  • Fever

  • Fatigue or tiredness

  • Weakness

 

Diagnosis

It’s recommended to visit a rheumatologist, a doctor specializing in arthritis and other related conditions, for a diagnosis within six months of onset of symptoms.  Find one here. In addition to a physical exam and review of symptoms, a diagnosis may include:

  • Blood tests to identify elevated erythrocyte sedimentation rates (ESR or sed rate) and C-reactive protein (CRP) levels, as well as rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

  • Imaging tests such as X-rays help track the progression of RA over time, while MRIs and ultrasound tests can determine the severity of the disease.

 

Complications

RA can cause pain, disability, and even premature death. Some complications include:

  • Premature heart disease and diabetes 

  • Osteoporosis, resulting from weakened bones due to RA and its medications 

  • Rheumatoid nodules, which are firm bumps of tissue often found around pressure points, such as the elbows, but also in the heart and lungs

  • Dry eyes and mouth or Sjogren's syndrome

  • Infections resulting from an impaired immune system

  • Abnormal body composition due to a high proportion of fat to lean mass, even in those with an average body mass index (BMI)

  • Carpal tunnel syndrome if RA affects the wrists

  • Heart problems from increased risk of hardened and blocked arteries, as well as inflammation of the sac that encloses the heart

  • Lung disease from an increased risk of inflammation and scarring of the lung tissues, leading to progressive shortness of breath

  • Lymphoma

 

Treatment

There is no cure for RA but, studies indicate that remission of symptoms is more likely when treatment begins early with disease-modifying antirheumatic drugs (DMARDs), although many of these drugs may cause serious side effects. 

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. 

  • Steroids or corticosteroid medications like prednisone reduce inflammation and pain and slow joint damage. They are often prescribed to relieve symptoms quickly, to gradually taper off the medication.

  • Conventional DMARDs slow the progression of RA and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine). 

  • Biologic agents or biologic response modifiers are a newer class of DMARDs and include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara) and tocilizumab (Actemra).  Biologic DMARDs are usually most effective when paired with a conventional DMARD, such as methotrexate. 

  • Targeted synthetic DMARDs such as baricitinib (Olumiant), tofacitinib (Xeljanz) and upadacitinib (Rinvoq) may be used if conventional DMARDs and biologics haven't been effective. Therapy

  • Physical therapy to keep joints strong and flexible

  • Occupational therapy to identify new ways to do daily tasks th

  • Synovectomy surgery to remove the inflamed lining of the joint 

  • Tendon repair to repair the tendons around your joint

  • Joint fusion to surgically fuse a joint to stabilize or realign it

  • Total joint replacement where a surgeon removes the damaged parts of the joint and inserts a prosthesis made of metal and plastic.

 

Lifestyle Changes and Self Care

There are several ways to help manage the symptoms and severity of RA including:

  • Rest when joints are inflamed because the risk of injury to joints and nearby soft tissue is high.

  • Exercise since inactivity can lead to a loss of joint motion and loss of muscle strength, resulting in decreased joint stability and increased pain and fatigue. Exercises such as walking, swilling and cycling assist with strength-building, and endurance. 

  • Maintain a healthy weight

  • Makes changes in diet to reduce inflammation

  • Assistive devices to make it easier to avoid stressing painful joints and to make daily tasks easier

  • Use of heat and cold. Heat, especially moist heat, can help muscles relax and ease pain. Cold can relieve muscle aches after exercise and decrease muscle spasms.

  • Attend regular healthcare appointments and discuss treatment with a doctor, including any supplements and OTC medications. 

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