Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and can affect other parts of the body. Various treatment options can help manage it.
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 after sleeping 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 Americans.
RA is an autoimmune disease, which means that a person’s immune system mistakes the body’s healthy tissues for foreign invaders. It is also a systemic disease that can affect the whole body.
As the immune system responds, inflammation occurs in the target tissue or organ. This can include the joints, lungs, eyes, and heart in RA.
Generally, doctors typically divide RA into two distinct types: Seropositive and seronegative.
People living with seropositive RA will have high levels of antibodies in their blood called anti-cyclic citrullinated peptides (anti-CCP). High levels of these antibodies can occur for up to 10 years before symptoms begin.
According to the Arthritis Foundation, about 60–80% of people diagnosed with RA will fall into the category of seropositivity. In addition, they may have another antibody in their blood called the rheumatoid factor (RF). However, this does not necessarily mean a person has RA, as the RF can also indicate other conditions.
In contrast, people with seronegative RA will not have these antibodies in their blood, making diagnosing more difficult.
There is a third type of RA called juvenile rheumatoid arthritis. Today, doctors call it juvenile idiopathic arthritis (JIA), which usually develops before age 16.
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
- a low-grade fever
- appetite loss
- weight loss
- joint deformity
- loss of function and mobility
- unsteadiness when walking
The following images show how RA can present physically:
According to the
People with RA usually experience periods when their 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.
Sometimes, a person with RA can go into remission if their 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 worsen 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.
As of 2014, the global prevalence rate of RA was about
RA tends to be more common in women than men. The risk of non-juvenile RA is highest in older adults between 65–80 years of age.
In addition, a
Nobody knows what causes the immune system to malfunction, which leads to RA.
In RA, the immune system attacks the synovium, the membrane lining of joints. When this happens, the synovial cells proliferate, which leads to synovial thickening. Pain and inflammation result.
Eventually, if left untreated, the inflammation 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 can eventually lose its shape and configuration, and the damage can be severe.
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 the typical 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 are experiencing RA or osteoarthritis, only a doctor can diagnose these conditions.
Learn more about the difference between RA and osteoarthritis here.
- are 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
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 the person has experienced them and how severe their symptoms are. They will also perform a physical examination to check for swelling, functional limitations, or other unusual presentations.
They also may recommend some tests, including:
Several blood tests can help diagnose RA and rule out other conditions. They include:
- rheumatoid factor
- erythrocyte sedimentation rate (ESR or sed rate)
- C-reactive protein (CRP)
Learn more here about blood tests for RA.
Imaging scans and X-rays
An X-ray or MRI of a joint
Learn what arthritis looks like on an MRI.
- number and location of affected joints
- blood tests indicate the presence of RA
- symptom duration
- inflammation indicators, or acute phase reactants
Learn more about how doctors diagnose RA.
Conditions with similar symptoms
A doctor will need to distinguish RA from other conditions with similar symptoms,
Learn about the differences and similarities between PsA and RA here.
If a person has a diagnosis of RA, a doctor may refer them to a specialist known as a rheumatologist, who will advise on treatment options.
- prevent flares and reduce their severity if they occur
- reduce inflammation in the joints
- relieve pain
- minimize any loss of function caused by pain, joint damage, or deformity
- slow down or prevent damage to joints and organs
Options include medications, physical therapy, occupational therapy, counseling, and surgery.
Learn more about swelling and inflammation in RA here.
Medications to manage symptoms
Some drugs can help relieve symptoms and slow the disease’s progression.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are available from pharmacies over the counter (OTC). Examples include Motrin, Advil, and Aleve. Long-term use and high doses can lead to side effects, including:
- 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 the symptoms.
Corticosteroids can help with acute symptoms or short-term flare-ups. However, a doctor will limit these injections to no more than three times per year because of their impact on the soft tissue structures around the joints. More frequent injections can potentially damage these structures or cause them to tear off from where they attach to bone.
Learn more about steroid injections here.
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 or Trexall) is an example of a DMARD.
DMARDs affect how the immune system works. They can slow the progression of RA and prevent permanent damage to joints and other tissues by interfering with an overactive immune system. A person usually takes DMARDs 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 their 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
- an increased risk of infections
- hair loss
- mouth ulcers
- nausea and loose stool
- abnormal blood counts
Learn more about the stages of RA here.
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 are conditions that damage the myelin sheath that normally protects nerve fibers
- skin reactions
Learn more about DMARDs and biologic drugs for RA.
Janus kinase (JAK) inhibitors are a newer subtype of DMARD medications. These include tofacitinib (Xeljanz), baricitinib (Olumiant), and upadacitinib (Rinvoq).
While traditional DMARDs stop the immune system from producing immune cells that cause RA to develop, JAK inhibitors target specific signaling molecules. This helps prevent the cellular process that causes RA to progress.
Learn more about JAK inhibitors.
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 on 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.
Which exercises can help people with RA?
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, a total joint replacement surgery
Several strategies can help a person manage their RA. Examples
- rest, especially during an RA flare
- low impact exercises, such as swimming, boost overall health and mobility and strengthen the muscles around a joint
- managing weight, which can prevent additional stress on 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 incorporating dietary advice, exercise suggestions, and other tips.
Learn about other natural remedies for RA here.
A varied and balanced diet can help control the inflammation that causes RA symptoms. It can also help a person manage their weight, reducing joint stress.
A Mediterranean diet is a good option for many people with RA. This diet
- 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 fats
- 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 foods rich in calcium and vitamin D 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 is a good idea for people to incorporate iron-rich foods into their diet, including:
- lean meats
- leafy greens
- fortified breakfast cereals
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:
- employment difficulties
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, a serious condition that can dislocate the joints at the top of the spine, causing pressure on the spinal cord
- cardiovascular disease, which is a general term for conditions affecting the heart or blood vessels, including a heart attack or stroke
Damage can occur in tendons near the joints. A person’s susceptibility to infections also may increase, and they have an increased risk of developing colds, flu, pneumonia, COVID-19, and other diseases, especially if they are taking immunosuppressant medications to manage their RA.
Learn more about the link between COVID-19 and RA here.
People with RA should ensure that their vaccinations, including annual flu shots, are up-to-date.
Some people with RA use the following complementary therapies:
- Acupuncture: A
2018 systemic reviewshows this may help a person relieve symptoms in combination with medication, but more research is necessary.
- Chiropractic manipulation: This therapy
appearsto provide significant pain relief to one person living with RA, but this is not sufficient to back up the effectiveness of this treatment.
- Massage: There is some evidence that massage
may helprelieve the symptoms of RA and other conditions, but there is not enough research to know for certain.
The following are answers to some common questions about RA.
What are the stages of rheumatoid arthritis?
RA generally develops in 4 stages:
Stage 1: An X-ray will not show any bone or joint destruction.
Stage 2: An X-ray will show the impact on the bone.
Stage 3: An X-ray will show a particular kind of erosion of the cartilage and bone that a doctor can recognize as resulting from RA and deformities in the affected joints.
Stage 4: The person will experience ankylosis, which is when a joint becomes stiff and fuses with the bone.
Is rheumatoid arthritis hereditary?
Research has determined that there are genes that make developing RA more likely. One theory is that bacteria or viruses trigger RA in people who have these genes. One of the genes that may be responsible is HLA-DR4, and it is common in people of European ancestry. However, this may not fully explain why some people get RA and others do not. There are likely environmental triggers also.
Can I prevent rheumatoid arthritis?
Researchers are looking at ways to prevent RA, but there are currently no specific ways to do this. They have been able to delay, but not prevent, the onset of RA. Currently, smoking is the only lifestyle factor that appears to have a strong link with RA, so quitting smoking may be able to reduce the risk.
Rheumatoid arthritis is a painful chronic autoimmune condition that can cause joint damage and make it difficult for a person to carry out their daily tasks. It can affect joints but can also lead to inflammation throughout the body.
Anyone who experiences pain and swelling in two or more joints not caused by trauma should see a doctor, as early treatment can reduce the risk of long-term problems.