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 America.
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 include:
- pain, swelling, and stiffness in more than one joint
- symmetrical joint involvement
- joint deformity
- unsteadiness when walking
- a general feeling of being unwell
- loss of function and mobility
- weight loss
According to the
Symptoms tend to come and go. During a remission, they can disappear, or they can be mild. However, during a flare, they can be severe.
Nobody knows what causes the immune system to malfunction and leads to RA.
Some people appear to have genetic factors that make it more likely, according to Genetics Home Reference. 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, which is 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.
- are age 60 years or above
- 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, 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.
In its early stages, it may be difficult for a doctor to diagnose RA as it can resemble other conditions. However, early diagnosis and treatment are essential to slow the progression of the disease.
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 deformity.
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
In 2010, the American College of Rheumatology (ACR) 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,
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
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 from pharmacies. Examples include Advil, Motrin, and Aleve. Long-term use and high doses can lead to side effects, such as bruising, gastric ulcers, high blood pressure, and 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. Long-term use of corticosteroids can have serious side effects, such as cataracts, osteoporosis, glaucoma, diabetes mellitus, and obesity. For this reason, a doctor will limit the number of times a person can receive these injections.
Disease-modifying antirheumatic drugs (DMARDs)
In 2015, the
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 up to 6 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, and an increased risk of infections.
Other side effects can include:
- 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.
Possible side effects
- a higher risk of infection
- congestive heart failure
- demyelinating diseases, where the myelin sheath that normally protects nerve fibers erodes
- 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 on the use of assistive devices, such as a cane, and can help the individual 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
A number of strategies can help a person manage RA. Examples include:
- rest, especially during a flareup
- low-impact exercise, such as swimming, to boost overall health and mobility and strengthen the muscles around a joint
- a varied, balanced diet with plenty of fresh fruits and vegetables
- managing weight, as this 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.
Some people with RA use the following, but there is little scientific evidence to confirm that they work:
- avoiding or quitting smoking
- following good hygiene practices to reduce the risk of infection, including good dental hygiene to avoid 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 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.