Whether you have just been diagnosed with rheumatoid arthritis (RA) or have
been living with this autoimmune disease for years, you no doubt have many
questions and concerns. To help you get up to speed on the best ways to manage
your RA today and for years to come, we took your top questions to
rheumatologist Linda A. Russell, MD, an assistant professor of medicine at
Weill Medical College of Cornell University and an assistant attending
physician at the Hospital for Special Surgery in New York City.
Diagnosing rheumatoid arthritis (RA) in the early stages can be difficult. There is no single test that can clearly identify rheumatoid arthritis. Instead, doctors diagnose rheumatoid arthritis based on factors that are strongly associated with the disease. The American College of Rheumatology uses this list of criteria:
Morning stiffness in and around the joints for at least one hour.
Swelling or fluid around three or more joints simultaneously.
At least one swollen area in the wrist,...
The precise cause of RA is not yet known. Some research suggests that genes
play a role. Other potential culprits include environmental factors such as
smoking, and also hormones, since women are two to three times more likely to
develop RA than men. Scientists have long suspected infectious agents such as
viruses and bacteria may play a role. Either a single factor or a combination
prompts the immune system to misfire, attacking its own joints and resulting in
pain and inflammation.
How is RA diagnosed today?
We take a thorough history, perform a physical exam, and then evaluate blood
work and X-rays. Currently two acceptable blood tests help us make an RA
diagnosis. We test for the presence of rheumatoid factor [RF] and anti-CCP
[anti-cyclic citrullinated peptide antibody]. [But] these blood tests are not
definitive. Anywhere from 10% to 30% of people with RA can be RF-negative or
When should I start seeing the effects of my new medication?
If you don’t start feeling better within three months, there is probably
reason to change or tweak your medication regimen. Feeling better means having
more energy, less morning stiffness, less joint pain, and less swelling.
When should I get a second opinion about my treatment?
Get one if you feel that your RA is active and your current doctor doesn’t
have anything else to offer or if you are concerned about the side effects of
your current medication regimen.
Is there a cure for RA?
Not yet—but many effective medications can control inflammation and help
prevent lasting joint damage. In the last 10 years, we have seen a whole new
class of drugs called biologics, which exert a greater control over
inflammation and have changed the course of RA. These drugs mimic the effects
of substances naturally made by the body’s own immune system. The biologics
target very specific inflammatory proteins called cytokines such as tumor
necrosis factor-alpha. Even with no cure, 10% of people with RA will go into
complete remission and be able to stop all of their medications
Will RA affect my chances of getting pregnant and having a healthy
Women with RA do not appear to have decreased fertility, and they often go
into remission during pregnancy. Women may have a flare within six to eight
weeks of giving birth. Breastfeeding might be problematic because if a woman
has a flare, she will need to resume taking her medications, and RA medications
can’t be taken while breastfeeding because the drugs can get into the milk