When rheumatoid arthritis flares up, it makes joints feel stiff and achy. That discomfort may go away at times, but there may still be permanent damage. Eventually rheumatoid arthritis can harm joints so they don't work as well even when the disease itself is not active. How does joint damage occur, and how can it be prevented?
Periods of active inflammation are called high disease activity. When joints are inflamed, white blood cells enter the joint space.
Rheumatoid arthritis affects about 1% of the population worldwide, but still misunderstanding swirls around this common and severe joint condition.
"There are so many misconceptions out there about rheumatoid arthritis," says Paul Kremer, MD, a rheumatologist and professor of medicine at Albany Medical College in New York.
"Arthritis is common, and rheumatoid arthritis often gets confused with the other kinds of arthritis in people's minds,” he says.
Plus, rheumatoid arthritis is still mysterious...
Inside the joint, these white blood cells produce chemicals that they usually use to kill invading microorganisms -- only no microorganisms are there. Instead, the chemicals damage the healthy joint tissue. During high levels of disease activity, you experience a flare -- joints become swollen, stiff, and painful. You can also have low levels of disease activity that come and go and have mild symptoms.
There are two main ways this process can cause joint damage:
The infection-fighting chemicals cause cartilage, the cushion between bones in the joint, to slowly degrade and thin.
The inflammation inside the joint stimulates the joint lining (synovium) to grow and spread where it doesn't belong. If it continues long enough, it can harm healthy cartilage or bone.
The simple rule of thumb is, the "longer" and "stronger" the disease activity, the more joint damage is probably occurring.
A person with joint swelling and stiffness every day is more likely to have joint damage than a person with these symptoms less often. (Longer disease activity)
Someone with a lot of joint swelling or lots of swollen joints is more likely to have damage than a person with just a little bit. (Stronger disease activity)
How can you tell if you are having disease activity? It can sometimes be difficult.
You can be feeling a lot of pain, but the cause could be from something other than RA.
Joint damage can also occur without causing much pain.
Joint swelling is a reliable sign, though. For the most part, having joint swelling is proof of having ongoing disease activity.
Tenderness when pressing on a joint is a reliable sign.
The length of morning stiffness each day can be useful. Ask yourself, after getting up, "How long does it take until I'm feeling as loose as I'll feel for the day?" The longer you feel stiff, the more likely it is that your rheumatoid arthritis is active.
Another sign you can look for is a "boggy" joint. When the joint lining begins to grow abnormally, it may give a joint a mushy texture. This boggy texture may remain even when you are not having a flare. If you notice this happening, you should see your rheumatologist.
If you are diagnosed with rheumatoid arthritis, your doctor will do a complete joint exam and get X-rays and blood tests. At later visits, you will be checked for any changes to your tests, and your doctor will address possible joint damage with you.
Because treatment for rheumatoid arthritis is improving, many experts believe that most people who now have it will develop less joint damage than ever before. You can gain control of rheumatoid arthritis and improve your chances by taking the following steps:
Get treated early. Much of the joint damage that eventually becomes serious starts soon after rheumatoid arthritis is discovered. The earlier you are treated, the less the chance of joint damage.
See your doctor often. People who see their rheumatologist regularly (several times a year) have less joint damage than people who do not.
Exercise! You can exercise without causing joint damage. In fact, exercise has the opposite effect -- regular exercise makes joints stronger. Your doctor will help you with an exercise plan that is safe, effective, and personalized for your fitness level and condition.
Rest when you need to. Finding the balance between rest and exercise is important so you don't overdo it.
Use a cane in the hand opposite a painful hip or knee. This reduces wear-and-tear on the affected joint.
Harris, E., Kelley's Textbook of Rheumatology, 7th edition, W.B. Saunders, 2005.
Klippel, J. Primer on the Rheumatic Diseases, 12th edition, Arthritis Foundation, 2001.
van Leeuwen, M., Journal of Rheumatology, 1994; vol 21: p 3.
Ward M., Archives of Internal Medicine, 1993; vol 153: p 2229.
Wolfe F., Journal of Rheumatology, 1991; vol 18: p 1290