Rheumatoid Arthritis: Signs and Treatment

Medically Reviewed by Jabeen Begum, MD on May 08, 2024
Written by Shawna Seed
15 min read

Rheumatoid arthritis is what doctors call an autoimmune condition. It starts when your immune system, which is supposed to protect you, goes awry and begins to attack your body’s tissues. It causes inflammation in the lining of your joints. As a result, your joints may get red, warm, swollen, and painful.

RA affects joints on both sides of the body, such as both hands, both wrists, or both knees. This symmetry helps to set it apart from other types of arthritis. Over time, RA can affect other body parts and systems, from your eyes to your heart, lungs, skin, blood vessels, and more.

 

This condition also is called juvenile idiopathic arthritis, or JIA. It causes swollen and stiff joints in children 16 or younger. If joint pain and stiffness last 6 weeks or longer, that may be JIA. 

Idiopathic means "unknown." Experts aren't sure what causes JIA. They think some children are born with a gene that makes them more likely to get JIA. Then something – such as a virus or bacteria – sets off the immune system. Researchers don't believe it's related to allergies, food, or poor diet.

Rheumatoid arthritis is a lifelong condition. Like RA, JIA is an autoimmune condition. But kids sometimes outgrow JIA. However, it can affect bone growth, which can have longer-term consequences. 

There are several types of JIA. 

Oligoarthritis. This is the most common type of JIA. It affects four or more joints and usually strikes larger joints such as knees, ankles, and elbows. 

Polyarthritis. When you have this type, five or more joints are affected, often on the same side of the body. About a quarter of children with JIA have this type. 

Systemic. About 10% of children with JIA get this type, which affects skin and internal organs as well as joints. Symptoms can include a fever above 103 F that lasts 2 weeks or more and a rash. 

Psoriatic arthritis (PsA). This type affects joints and also causes a scaly rash. The rash often appears on the eyelids, knees, belly button, and scalp or behind the ears. Wrists, ankles, fingers, and toes are some of the joints that might be affected. 

Enthesitis-related. Another name for this type is spondyloarthritis. It hits areas where muscles, ligaments, and tendons attach to bone. Hips, knees, and feet are the most common spots affected, but any joint can be involved. It also can affect the digestive tract. It's more common in boys and generally starts between the ages of 8 and 15.

Undifferentiated. Doctors use this label when it's clear that at least one joint is inflamed, but other symptoms don't match up with the other types. 

The warning signs of RA are:

  • 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 happen 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.

Early rheumatoid arthritis symptoms

Your joints might be tender and painful, even though you don't see redness or swelling. The first joints affected might be smaller ones, such as where your fingers attach to your hand and your toes to your feet.

Rheumatoid arthritis rash

RA can affect your skin as well as your joints. You might get firm lesions, called nodules, on your body. Another skin symptom is called vasculitis. One symptom of RA vasculitis is pits developing in your fingernails. Vasculitis also can cause a rash that might be raised or flat. It might look like bruises. The rash doesn't go away when you press on it. It often affects knees and lower legs.

Unusual symptoms of rheumatoid arthritis

RA can affect your entire body. Beyond painful and swollen joints, you might experience: 

  • Fatigue
  • Low-grade fever
  • Dry, sensitive eyes
  • Dry mouth and gum irritation or infection
  • Shortness of breath 
  • Low red blood cell count 
  • Damage to your heart muscle

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.

Things that increase your risk of RA include: 

  • Family history of RA
  • Smoking 
  • Being overweight

Doctors don’t know the exact cause. Something seems to trigger the immune system to attack your joints and, sometimes, other organs. Some experts think a virus or bacteria may change your immune system, causing it to attack your joints. 

Is rheumatoid arthritis hereditary?

Experts believe there are multiple genes that can make you vulnerable to RA. They estimate that if a family member has RA, your chances of inheriting it are about 60%. Researchers are looking at a number of genes, including those in  the HLA Class II family. 

 

Immune system cells move from the blood into your joints and the tissue that lines them. This tissue is called the synovium. Once the cells arrive, they create inflammation. This makes your joint swell as fluid builds up inside it. Your joints become painful, swollen, and warm to the touch.

Over time, the inflammation wears down the cartilage, a cushy layer of tissue that covers the ends of your bones. As you lose cartilage, the space between your bones narrows. As time goes on, they could rub against each other or move out of place. The cells that cause inflammation also make substances that damage your bones.

The inflammation in RA can spread and affect organs and systems throughout your body, from your eyes to your heart, lungs, kidneys, blood vessels, and even your skin.

Rheumatoid arthritis in hands

In addition to swelling, pain, and stiffness, RA can affect your hands in these ways: 

  • A soft lump develops on the back of your hand.
  • Swelling of the fingers makes them look like sausages.
  • A creaking sound happens when you move your fingers.
  • A clicking sound happens when you bend your finger joints.
  • You can't straighten your fingers or thumb.
  • The tip of your finger may be bent. 
  • The middle joint of your finger is bent and your fingertip is straightened too far.

Rheumatoid arthritis in feet

The most common symptoms are swelling, pain, and stiffness. Other symptoms include: 

  • Trouble with ramps and stairs if your ankle is affected 
  • Trouble walking on uneven surfaces, such as grass or gravel
  • Arch collapse, making the front of your foot point out
  • Bony bumps that make it hard to wear shoes
  • Bunions and claw toes (toes permanently bent) 

Health care professionals divide RA into four stages. 

Stage 1. You have inflammation around your joints. They might be painful and stiff. X-rays won't show any damage to your bones.

Stage 2. You start to have damage to your cartilage. You may notice that your range of motion in your affected joints is limited. You feel some stiffness. 

Stage 3. Your bones begin to show damage. You have pain, stiffness, and even less range of motion. 

Stage 4. Although the inflammation has stopped, the condition of your joints gets worse. You have more pain, stiffness, and trouble moving. 

RA can raise your risk of other conditions.

Skin effects

You might get lumps of tissue called rheumatoid nodules. They usually appear on your skin, especially on elbows, forearms, heels, or fingers. They can show up suddenly or grow slowly. The nodules may be a sign that your rheumatoid arthritis is getting worse. They can also form in places like your lungs and heart.

Vasculitis, when it affects larger arteries, can lead to nerve damage, problems using your arms or legs, or damage to your internal organs.

Other types of skin problems related to RA may appear, so always let your doctor know about anything new that pops up or breaks out.

Eye complications

Rheumatoid arthritis can affect your eyes in several ways. Inflammation of the episclera, a thin membrane that covers the whites of your eyes, is common. It’s usually mild, but your eyes may be red and painful. Scleritis, an inflammation of the whites of the eyes, is more serious and can lead to vision loss.

RA also puts you at risk for Sjogren's syndrome. This happens when your immune system attacks the glands that make tears. It can make your eyes feel gritty and dry. It can also show up as dry skin, dry coughing, or vaginal dryness. You may need to use eye lubricants or take medications. Without treatment, eye dryness can cause infection and scarring of the conjunctiva, which is the membrane that covers the eye, and the cornea, the clear dome at the front of your eye.

Neck pain

Rheumatoid arthritis often causes pain in the joints of the fingers and wrists. But it can also affect other parts of your body, like your neck. If your neck feels stiff and you have pain when you turn your head, it could be RA.

Some simple exercises might help. Talk to your doctor about the best treatments to ease your neck pain.

Heart and blood vessel disease

Pericarditis, or inflammation of the membrane that surrounds your heart, usually develops during flares. Flares are times when your RA is worse.

If it happens a lot, pericarditis can make the membrane thicker and tighter. That can interfere with your heart's ability to work the way it should.

Rheumatoid nodules can also form on the heart and affect the way it works.

Inflammation of the heart muscle itself, called myocarditis, is a rare complication.

Rheumatoid arthritis can make you more likely to get cardiovascular disease. It also raises your risk of stroke. This is probably related to long-term inflammation. Heart disease doesn't always have symptoms before a crisis. Your doctor can spot some problems during a checkup and may recommend lifestyle changes or medication.

Blood disease

Rheumatoid arthritis or some of the medications that treat it can lower your number of healthy red blood cells, which carry oxygen around your body. This is called anemia. Anemia symptoms include:

  • Fatigue
  • Rapid or uneven heartbeat
  • Shortness of breath
  • Dizziness
  • Headaches
  • Weakness
  • Leg cramps
  • Insomnia, or sleeplessness

Thrombocytosis is another complication from RA. This happens when inflammation leads to high levels of platelets in your blood. Platelets help your blood clot in order to stop bleeding, but too many can lead to conditions like stroke, a heart attack, or clots in your blood vessels.

Felty’s syndrome is an unusual complication with rheumatoid arthritis. This is when your spleen is enlarged and your white blood cell count is low. It can raise your risk of lymphoma, a cancer of the lymph glands.

Lung problems

Rheumatoid arthritis can cause inflammation in your lungs, which can lead to pleuritis (pleurisy), a condition that makes breathing painful. Rheumatoid nodules can form in your lungs, too. They’re usually harmless but can lead to problems such as a collapsed lung, coughing up blood, infection, or pleural effusion, which is fluid buildup between the lining of your lung and your chest cavity.

Interstitial lung diseases, which involve scarring of the lung tissue, and pulmonary hypertension, a type of high blood pressure that damages arteries in the lung and heart, can be complications of RA. Rarely, the drug methotrexate, which many people with RA take, can also cause lung problems. You might not notice any symptoms, so your doctor may want to do tests to watch for problems.

Osteoporosis

Osteoporosis makes your bones fragile and thin, so they’re more likely to break. People with RA are at higher risk of getting it. The disease may also cause bone loss, and so can some medications, like steroids. Also, if RA pain makes you less active, you might be more likely to get osteoporosis.

Symptoms of osteoporosis include back pain, stooped posture, a curved upper back, and fractures. You might also lose height.

Diabetes

Research shows that RA raises your risk for diabetes by about 50%. And diabetes raises your risk of arthritis, including RA and related issues, by about 20%.

Experts aren't sure why these two diseases are linked. Several things may play a role:

  • RA and type 1 diabetes are both autoimmune diseases.
  • RA and diabetes both cause inflammation.
  • The stiffness and pain of RA can keep you from getting enough physical activity, a risk factor for type 2 diabetes.

Some medications that treat RA also affect your risk of diabetes. Steroids and statins can raise your blood sugar and make you more likely to get the disease. But other RA drugs may protect against it, including hydroxychloroquine, abatacept (Orencia), and a group of medicines called TNF inhibitors.

Infections

You may get more infections if you have rheumatoid arthritis. This could be from the condition itself or from the immune-suppressing medicine that treats it.

Emotional effects

Living every day with the pain of a chronic condition can take a toll. One study shows that almost 11% of people with rheumatoid arthritis had symptoms of depression. The more severe the RA, the more depression the participants felt. Symptoms include:

  • Deep feelings of sadness, anxiety, emptiness, hopelessness, worthlessness, or guilt
  • Loss of interest in things you once enjoyed
  • Insomnia
  • Trouble concentrating or making decisions

If you have rheumatoid arthritis and feel anxious or depressed, discuss it with your doctor. There are many things they can offer that will help you feel better.

Early on, RA is hard to diagnose in part because it has symptoms in common with so many other conditions. There is no single test that shows whether you have RA. Your doctor will give you a checkup, ask you about your symptoms, and perform certain tests.

Your doctor may suspect RA based on: 

  • The location and symmetry of painful joints, especially the hand joints
  • Joint stiffness in the morning
  • Bumps and nodules under the skin (rheumatoid nodules)

Rheumatoid arthritis vs. osteoarthritis

These are both conditions that affect your joints. Osteoarthritis is caused by wear and tear on your joints during your lifespan. RA is an autoimmune disorder.

Rheumatoid arthritis criteria

Doctors look at your symptoms and certain test results to determine whether you have RA. This is called the diagnostic criteria. You can have RA without meeting each of the criteria. They are: 

  • Inflammatory arthritis in two or more large joints, such as ankles, knees, hips, shoulders, and elbows
  • Inflammatory arthritis in smaller joints 
  • A positive test for RA biomarkers 
  • An elevated level of certain substances in your body
  • Symptoms that have lasted longer than 6 weeks

Rheumatoid arthritis tests 

Your doctor may order X-rays to look for damage to your joints.

You also may have blood drawn for testing. Things your doctor will check for include: 

Anemia. People with rheumatoid arthritis may have a low number of red blood cells.

C-reactive protein (CRP). High levels of this substance are a sign of inflammation. Some people with rheumatoid arthritis also may have a positive antinuclear antibody test (ANA), which indicates an autoimmune disease, but the test does not specify which autoimmune disease.

Cyclic citrulline peptide antibody test (anti-CCP). This more specific test checks for anti-CCP antibodies, which suggest you might have a more aggressive form of rheumatoid arthritis.

Erythrocyte sedimentation rate (ESR). How fast your blood clumps up in the bottom of a test tube shows there may be inflammation in your system.

Rheumatoid factor (RF). Most, but not all, people with rheumatoid arthritis have this antibody in their blood. But it can show up in people who don’t have RA.

Treatments include medications, rest, exercise, and, in some cases, surgery to correct joint damage.

Your options will depend on several things, including your age, overall health, medical history, and how severe your case is.

Rheumatoid arthritis medications

Many rheumatoid arthritis medications can ease joint pain, swelling, and inflammation. Some of these drugs prevent or slow down the disease.

Drugs that ease joint pain and stiffness include:

  • Anti-inflammatory painkillers like aspirin, ibuprofen, and naproxen
  • Pain relievers that you rub on your skin
  • Corticosteroids like prednisone
  • Pain relievers such as acetaminophen

Your doctor will typically give you strong medications called disease-modifying antirheumatic drugs (DMARDs). They work by interfering with or suppressing your immune system's attack on your joints.

Traditional DMARDs. These are often the first treatment for RA:

  • Hydroxychloroquine (Plaquenil), which was created to treat malaria
  • Leflunomide (Arava)
  • Methotrexate (Rheumatrex, Trexall), which was first developed to treat cancer
  • Sulfasalazine (Azulfidine)

Biologic response modifiers. These are lab-made versions of proteins in human genes. They’re an option if your RA is more severe or if DMARDs didn’t help. You might take a biologic and a DMARD together. The doctor could also give you a biosimilar. These new drugs are near-exact copies of biologics that cost less. Biologics approved for RA include:

  • Abatacept (Orencia)
  • Adalimumab (Humira), adalimumab-adaz (Hyrimoz), adalimumab-adbm (Cyltezo), adalimumab-afzb (Abrilada), adalimumab-atto (Amgevita), adalimumab-bwwd (Hadlima), and adalimumab-fkjp (Hulio)
  • Anakinra (Kineret)
  • Belimumab (Benlysta)
  • Certolizumab (Cimzia)
  • Etanercept (Enbrel), etanercept-szzs (Erelzi), and etanercept-ykro (Eticovo)
  • Golimumab (Simponi, Simponi Aria)
  • Infliximab (Remicade), nfliximab-abda (Renflexis), infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), and infliximab-qbtx (Ixifi)
  • Rituximab (Rituxan)
  • Sarilumab (Kevzara)
  • Tocilizumab (Actemra)

Targeted synthetic DMARDs. If other drugs don't work, your doctor may want you to try this type of drug. Medications in this group include: 

  • Baricitinib (Olumiant)
  • Tofacitinib (Xeljanz)
  • Upadacitinib (Rinvoq)

Rheumatoid arthritis Ayurvedic treatment

Ayurvedic medicine is a traditional system based on the idea that stress or imbalance in your life causes illness. It focuses on lifestyle changes and using natural substances such as herbs to improve your health. One small study found Ayurvedic treatment as effective as methotrexate, but generally, there's not much evidence that Ayurvedic medicine works for RA. The FDA warns that some Ayurvedic treatments contain metals – especially lead and mercury – that could be harmful. If you're interested in trying Ayurvedic treatment, talk to your doctor first. Very few regulations control Ayurvedic practitioners in the U.S. Always let your doctors know of any supplements you take or alternative therapies you're using. 

Rheumatoid arthritis home remedies

There are some things you can try at home that might ease your RA symptoms. Research suggests treatments that might help include: 

Fish oil. These supplements might ease your pain and stiffness. If you take it, you might experience nausea, indigestion, and a fishy taste in your mouth. Fish oil can interfere with some medicines, so check with your doctor first. 

Plant oils. Evening primrose, borage, and black currant contain substances that might reduce your pain and morning stiffness. Some people who take them get headaches and an upset stomach. These oils also can interfere with medication and may cause liver problems. Discuss with your doctor whether plant oils might benefit you. 

Tai chi. This type of exercise focuses on gentle moves, stretches, and deep breathing. There's some evidence it can improve your quality of life with RA. If you're working with a qualified teacher, tai chi is safe. But don't do any moves that hurt.

You can take steps – in addition to medication – to help manage your symptoms:

Exercise. You can strengthen muscles around your affected joints with gentle exercise. It also may improve your fatigue. Check with your doctor before you start a workout program. Don't put stress on joints that are tender. Low-impact exercises to try include swimming, walking, cycling, and water aerobics.

Heat and ice. When you apply heat to an affected joint, it can ease pain and relax stiff muscles. When you apply cold to your joint, the numbing effect can dull your pain. Cold also can reduce swelling. 

Relaxation. Techniques such as breathing exercises and guided imagery can help reduce your stress and may help ease pain. 

Sleep. You need your rest to help your body cope with RA. Limit caffeine late in the day, stay off electronic devices before bedtime, and make sure you take your medicine on schedule. 

Education. Programs that teach self-management skills for people with chronic diseases can improve your quality of life. Ask your doctor for information about local programs.

Rheumatoid arthritis diet

Changing what you eat may help with your RA symptoms. Adding healthy fats, and avoiding unhealthy fats and processed foods high in carbohydrates, can help reduce inflammation. You might also lose weight, which can ease stress on your joints. If you have RA, you're at higher risk of cardiovascular disease. Moving toward a heart-healthy diet can reduce your chances of heart disease. 

Rheumatoid arthritis is an autoimmune disorder that can affect your joints as well as other parts of your body. When you have it, your joints become swollen, painful, and stiff. There's no cure for RA, but treatments can help relieve your symptoms. Lifestyle changes, such as altering your diet, getting plenty of rest, and low-impact exercise, also may ease the effects of RA. 

Why are rest and exercise important for RA?

You need to be active, but you also have to pace yourself. During flare-ups, when inflammation gets worse, it’s best to rest your joints. Using a cane or joint splints can help.

When the inflammation eases, it’s a good idea to exercise. It’ll keep your joints flexible and strengthen the muscles that surround them. Low-impact activities, like brisk walking or swimming, and gentle stretching can help. You may want to work with a physical therapist at first.

When Is surgery needed for rheumatoid arthritis?

When joint damage from rheumatoid arthritis has become severe, surgery may help. Among the procedures used for RA are:

  • Synovectomy, which removes the inflamed lining of the joint 
  • Tendon repair
  • Joint fusion, which can make a joint more stable 
  • Joint replacement

Is there a cure for rheumatoid arthritis?

Although there isn't a cure for rheumatoid arthritis, early, aggressive treatment will help prevent disability and increase your chances of remission.