Rheumatoid arthritis (RA) is a chronic, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and can affect other body organs.
RA usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body.
Common symptoms include stiff joints, especially when getting up in the morning or after sitting down for a while. Some people experience fatigue and a general feeling of being unwell.
The Rheumatoid Arthritis Support Network estimates that RA affects up to 1% of the world’s population and over 1.3 million people in the United States.
RA is an autoimmune disease. It is also a systemic disease, which means it can affect the whole body. It occurs when a person’s immune system mistakes the body’s healthy tissues for foreign invaders.
As the immune system responds, inflammation occurs in the target tissue or organ. In the case of RA, this can be the joints, lungs, eyes, and heart.
Signs and symptoms of RA usually occur in the wrists, hands, or feet and include:
- pain or achiness in more than one joint
- stiffness in more than one joint that lasts longer than 30 minutes
- swelling in more than one joint
- symmetrical joint involvement
- a general feeling of being unwell
- low-grade fever
- appetite loss
- weight loss
- joint deformity
- loss of function and mobility
- unsteadiness when walking
According to the
People with RA usually experience periods when symptoms get worse, known as flares. RA symptoms may flare up due to stress, overactivity, or stopping medications.
Learn how to manage RA flares here.
Flares are followed by remissions when symptoms go away or are mild. Most people continue to experience flares and remissions throughout their lives.
Learn how to achieve RA remission here.
RA usually affects the same joints on both sides of the body. Pain and stiffness tend to get worse after sleep or periods of inactivity.
Severe RA can lead to other complications throughout the body and cause joint damage that may lead to disability. Treatment can help manage the severity of symptoms and may reduce the likelihood of experiencing complications.
The images below show how RA can appear in different parts of the body.
If a person has a diagnosis of RA, the doctor may refer them to a specialist known as a rheumatologist, who will advise on treatment options.
Treatment will aim to:
- prevent flares and reduce their severity if they occur
- reduce inflammation to the joints
- relieve pain
- minimize any loss of function caused by pain, joint damage, or deformity
- slow down or prevent damage to the joints and organs
Options include medications, physical therapy, occupational therapy, counseling, and surgery.
Medications to manage symptoms
Some drugs can help to relieve symptoms and slow disease progression.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter (OTC) from pharmacies. Examples include Motril, Advil, and Aleve. Long-term use and high doses can lead to side effects. These include:
- gastric ulcers
- high blood pressure
- kidney and liver problems
Corticosteroids reduce pain and inflammation and may help slow joint damage, but they cannot cure RA. If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of symptoms.
Corticosteroids can help with acute symptoms or short-term flareups. However, a doctor will limit these injections to no more than three times per year because of their impact on the soft tissue structures in the joints. More frequent injections can potentially damage these structures or cause them to tear off where they attach to the bone.
Disease-modifying antirheumatic drugs (DMARDs)
The American College of Rheumatology (ACR) recommends treatment with disease‐modifying antirheumatic drugs (DMARDs), either alone or with other treatments, in people with moderate to severe RA. Methotrexate (Rheumatrex, Trexall) is an example of a DMARD.
DMARDs affect how the immune system works. They can slow the progression of the RA and prevent permanent damage to the joints and other tissues by interfering with an overactive immune system. A person usually takes a DMARD for life.
These types of medications are most effective if a person uses them in the early stages of RA, but it can take several weeks to a couple of months to fully experience the benefits. Some people may have to try different types of DMARDs before finding the most suitable one.
Side effects can include:
- liver damage
- immune-related disorders
- increased risk of infections
- hair loss
- mouth ulcers
- nausea, stomach upset, and loose stool
- abnormal blood counts
Biologic treatments, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, also change how the immune system works. When the human body faces an infection or other threat, it produces TNF-alpha, an inflammatory substance. TNF-alpha inhibitors suppress this substance and help prevent inflammation.
TNF-alpha inhibitors can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an improvement 2 weeks after starting treatment.
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi
- infliximab (Remicade)
Possible side effects
- a higher risk of infection
- congestive heart failure
- demyelinating diseases, which damage the myelin sheath that normally protects nerve fibers
- skin reactions
Occupational or physical therapy
An occupational therapist can help a person learn new and effective ways of carrying out daily tasks. This can minimize stress to painful joints. For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.
A physical therapist can advise people about using assistive devices, such as a cane, and help individuals develop a suitable exercise plan.
In some cases, a doctor may recommend surgery to:
- repair damaged joints
- correct deformities
- reduce pain
The following procedures are possible:
- arthroscopic surgery, a procedure to remove inflamed joint tissue
- surgery to release tendons responsible for unusual bending in the fingers
- carpal tunnel release to relieve nerve compression in the hand and wrist
- arthroplasty, or total joint replacement
Several strategies can help a person manage RA. Examples include:
- rest, especially during an RA flare
- low-impact exercise, such as swimming, to boost overall health and mobility and strengthen the muscles around a joint
- managing weight, which can prevent additional stress on the joints
- applying heat or cold packs
- meditation, guided imagery, deep breathing, or muscle relaxation to relieve stress
A healthcare professional can help a person make a plan that incorporates dietary advice, suggestions for exercise, and other tips.
Learn about other natural remedies for RA here.
A varied, balanced diet can help control the inflammation that causes RA symptoms. It also helps a person to manage their weight, which reduces stress on the joints.
A Mediterranean diet is a good option for many people with RA. This diet focuses on inflammation-fighting foods, such as:
- plenty of fresh fruits and vegetables, which are rich in antioxidants
- fatty fish, such as salmon or tuna, which are high in omega-3 fatty acids
- olive oil, which has heart-healthy monounsaturated fat
- nuts, which are also a great source of monounsaturated fats and other nutrients
- whole grains, which have fiber and antioxidants to help boost heart health
- legumes, including peas and beans, which are a healthy source of protein
People with RA should additionally eat calcium-rich foods to support strong bones, as some RA medications can increase the risk of osteoporosis. Good sources include low fat dairy and dark leafy green vegetables.
Because anemia can occur during RA flare-ups, causing fatigue, it’s a good idea for a person to incorporate iron-rich foods into their diet, including:
- lean meats
- leafy greens
- fortified breakfast cereals
Nobody knows what causes the immune system to malfunction, leading to RA.
Some people appear to have genetic factors that make developing RA more likely. One theory is that bacteria or a virus triggers RA in people who have this genetic feature.
In RA, the immune system’s antibodies attack the synovium, the smooth lining of a joint. When this happens, pain and inflammation result.
Inflammation causes the synovium to thicken. Eventually, if left untreated, it can invade and destroy cartilage — the connective tissue that cushions the ends of the bones.
The tendons and ligaments that hold the joint together can also weaken and stretch. The joint eventually loses its shape and configuration. The damage can be severe.
Learn more about genetic and hereditary RA here.
RA is an autoimmune disease that causes inflammation in the joints, leading to pain, stiffness, and swelling. Osteoarthritis leads to many of the same symptoms as RA but is due to normal wear and tear of the joints.
While RA usually affects the same joints on both sides of the body, osteoarthritis may only affect one side.
Although other symptoms can help a person figure out if they’re experiencing RA or osteoarthritis, only a doctor can diagnose these conditions.
- 60 years or older
- are female
- have specific genetic traits
- have never given birth
- have obesity
- smoke tobacco or whose parents smoked when they were children
People with RA have a higher risk of some other conditions, including:
The joint damage that occurs with RA can make it difficult to perform daily activities. RA can also be unpredictable. Often, a person does not know when a flare will happen.
This uncertainty can lead to:
There is also a higher risk of developing various other conditions, including:
- carpal tunnel syndrome, which can cause aching, numbness, and tingling in the fingers, thumb, and part of the hand
- inflammation, which can affect the lungs, heart, blood vessels, eyes, and other parts of the body
- cervical myelopathy, due to inflammation and destruction of synovial tissue in the cervical spine
- vasculitis, or inflammation of the blood vessels, which can affect blood flow to tissues and affect organ function
Damage can occur in tendons near the joints. Susceptibility to infections also may increase, and a person has an increased risk of developing colds, flu, pneumonia, COVID-19, and other diseases, especially if they are taking immunosuppressant medications to manage RA.
People with RA should ensure that their vaccinations, including annual flu shots, are up to date.
Learn more about the flu jab and RA here.
It may be difficult for a doctor to diagnose RA in its early stages, as it can resemble other conditions.
A doctor will look at the person’s clinical signs of inflammation and ask how long they have been there and how severe the symptoms are. They will also carry out a physical examination to check for any swelling, functional limitations, or other unusual presentations.
They also may recommend some tests, including:
A number of blood tests can help diagnose RA and rule out other conditions. They include:
- anti-cyclic citrullinated peptide (anti-CCP)
- rheumatoid factor
- erythrocyte sedimentation rate (ESR or sed rate)
- C-reactive protein (CRP)
Imaging scans and X-rays
2010 guidelines recommended the following criteria for diagnosing RA:
- swelling is present in at least one joint, and it does not have another cause
- results from at least one blood test indicate the presence of RA
- symptoms have been present for at least 6 weeks
Conditions with similar symptoms
The doctor will need to distinguish RA from other conditions with similar symptoms,
Some people with RA use the following complementary therapies, but there is little scientific evidence to confirm that they work:
Researchers are looking at ways to prevent RA, but there is no specific way to do this. They have been able to delay but not prevent the onset of RA.
Lifestyle practices that may help include:
- avoiding or quitting smoking
- following good hygiene practices to reduce the risk of infection, including good dental hygiene to prevent gum disease
- following a diet rich in fresh fruits and vegetables, which contain antioxidants
Currently, smoking is the only lifestyle factor that appears to have a strong link with RA.
RA is a painful and chronic autoimmune condition that can cause joint damage and make it difficult for a person to carry out their daily tasks. It can affect the joints but also lead to inflammation throughout the body.
Anyone who experiences non-traumatic pain and swelling in two or more joints should see a doctor, as early treatment can reduce the risk of long-term problems.