What Are the Symptoms?
- Joint pain and swelling
- Stiffness, especially in the morning or after you sit for a long time
Rheumatoid arthritis affects everyone differently. For some, joint symptoms develop gradually over several years. In others, it may come on quickly.
Some people may have rheumatoid arthritis for a short time and then go into remission, which means they don’t have symptoms.
Who Gets Rheumatoid Arthritis?
Anyone can get RA. It affects about 1% of Americans.
The disease is two to three times more common in women than in men, but men tend to have more severe symptoms.
It usually starts in middle age. But young children and the elderly also can get it.
What Causes It?
Doctors don’t know the exact cause. Something seems to trigger the immune system to attack the joints and sometimes other organs. Some experts think that a virus or bacteria may change the immune system, causing it to attack the joints. Other theories suggest that in some people, smoking may lead to rheumatoid arthritis.
Certain genetic patterns may make some people more likely to get RA than others.
How Does It Affect the Body?
Immune system cells move from the blood into the joints and joint-lining tissue, called synovium. Once they arrive, those immune system cells create inflammation that leads to irritation, which wears down cartilage (the cushioning material at the end of bones). As the cartilage wears down, the space between the bones narrows. As it gets worse, the bones could rub against each other.
Inflammation of the joint lining causes swelling and makes fluid build up within the joint. As the lining expands with inflammatory cells, it can produce substances that damage the bone.
All of these things cause the joint to become very painful, swollen, and warm to the touch.
How Do Doctors Diagnose Rheumatoid Arthritis?
There is no single test that shows whether you have RA. Your doctor will give you a checkup, ask you about your symptoms, and possibly perform X-rays and blood tests.
Rheumatoid arthritis is diagnosed from a combination of things, including:
- The location and symmetry of painful joints, especially the hand joints
- Joint stiffness in the morning
- Bumps and nodules under the skin (rheumatoid nodules)
- Results of X-ray and blood tests
Most, but not all, people with rheumatoid arthritis have the rheumatoid-factor (RF) antibody in their blood. Rheumatoid factor may sometimes be present in people who do not have rheumatoid arthritis. Therefore, the diagnosis of rheumatoid arthritis is based on a combination of joint problems, as well as test results.
A newer, more specific blood test for rheumatoid arthritis is the cyclic citrulline antibody test, also called anti-CCP. The presence of anti-CCP antibodies suggests a tendency toward a more aggressive form of rheumatoid arthritis.
People with rheumatoid arthritis may have mild anemia. Blood tests may also show an elevated erythrocyte sedimentation rate (ESR) or elevated C-reactive protein (CRP) levels, which are signs of inflammation.
Some people with rheumatoid arthritis may also have a positive antinuclear antibody test (ANA), which indicates an autoimmune disease, but the test does not specify which autoimmune disease.
How Is RA Treated?
Your treatment will depend on several things, including your age, overall health, medical history, and how severe your case is.
Drugs that ease joint pain, stiffness, and swelling include:
- Anti-inflammatory painkillers, such as aspirin, ibuprofen, or naproxen
- Pain relievers that you put on your skin
- Corticosteroids, such as prednisone
- Narcotic pain relievers
There are also many strong medications called disease-modifying antirheumatic drugs (DMARDs), which work by interfering with or suppressing the immune system's attack on the joints. They include:
- hydroxychloroquine (Plaquenil), originally used to treat malaria)
- Immune suppression drugs, such as methotrexate
- Biologic treatments, such as abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi and Simponi Aria), infliximab (Remicade), infliximab-dyyb (Inflectra, a biosimilar), rituximab (Rituxan), and tocilizumab (Actemra)
- Other drugs, such as leflunomide (Arava), sulfasalazine (Azulfidine), and tofacitinib (Xeljanz)
Why Are Rest and Exercise Important for RA?
You need to be active, but you also have to pace yourself. During flare-ups, when joint inflammation gets worse, it’s best to rest the joints. Using a cane or joint splints can help during flare-ups.
When joint inflammation gets better, you need to exercise to your keep joints flexible and to strengthen the muscles that surround them. Low-impact activities, such as brisk walking or swimming, and gentle stretching can help. You may want to work with a physical therapist at first.
When Is Surgery Needed?
When joint damage from the rheumatoid arthritis has become severe or pain is not controlled with drugs, surgery may help.
Is There a Cure?
Although there isn't a cure for rheumatoid arthritis, early, aggressive treatment has been shown to help prevent disability and increase the chance to attain remission.