Why RA Is Different for Everyone

Medically Reviewed by Jennifer Robinson, MD on September 15, 2022
4 min read

Rheumatoid arthritis (RA) is a disorder in which your immune system attacks your body’s own tissues. Diagnosis and treatment for RA used to be the same for everyone who had it. But it’s now clear that the symptoms, the way it progresses, and how serious it is vary from person to person, partly based on their genes. That means the treatments often differ too.

The three main types of RA are:

Seropositive. This means your blood tests found substances called anti-cyclic citrullinated peptides (anti-CCPs) or rheumatoid factor (RF). Anti-CCPs and RFs are antibodies that cause symptoms of RA.

About 75% to 80% of people with RA have anti-CCPs, RF, or both. They can also show up on blood tests anywhere from 5-10 years before you have any symptoms of rheumatoid arthritis.

Seronegative. When you have seronegative rheumatoid arthritis, anti-CCPs and RFs don't show up in your blood. So your doctor will look for other things to tell whether you have RA.

Juvenile Ideopathic Arthritis. Formerly called juvenile rheumatoid arthritis, this affects people under age 16. It's the most common type of arthritis in this age group. Doctors diagnose it through blood tests, X-rays, and other scans.

Beyond these three categories, doctors think RA has many different subgroups. It's not one specific disease, but a set of conditions that differ based on your genetic makeup. That's why different people with RA can all feel very differently.

You might not have the same symptoms as someone else with RA. But some of the more common ones include:

RA usually affects your smaller joints first, like those that attach your fingers to your hands and your toes to your feet.

You may also have problems that have nothing to do with your joints. About 40% of people with RA have symptoms that affect their:

The longer you have the condition, the more your symptoms may spread. RA may eventually affect your wrists, ankles, knees, shoulders, hips, and elbows. But the right treatments can slow down or stop this process.

RA symptoms can be mild, serious, or anywhere in between. You may have flares, when your symptoms are worse. Then you might have periods of remission when they aren’t as strong or go away.

Sometimes, people with seronegative RA have less intense symptoms than those with seropositive RA. But this isn’t always true. Genetics and other health conditions you have play a role in how bad your symptoms are.

When your immune system attacks your body’s tissue, it destroys cartilage and bone around your joints. Doctors don’t know what causes this to start. But they think it's linked to your genes.

Your genes don’t cause RA directly. But they can make you more likely to react to things in your environment, like infections, that may trigger rheumatoid arthritis.

Some other things raise your risk for RA:

Age. You can get rheumatoid arthritis at any point, but it’s most common in middle-aged people.

Sex. Women are more likely to get RA.

Family history. If someone in your family has RA, you have a greater chance of getting it too.

Smoking. If you smoke cigarettes, your chance of RA goes up. That's especially true if it runs in your family.

Your environment. You might be more likely to get RA if you come into contact with certain minerals, like asbestos or silica. But we need more research into this.

Obesity. If you’re overweight, you’re more likely to get RA.

Although there’s no cure for RA, you can do many things to help you feel better.

Medication. Your doctor will recommend different drugs based on what symptoms you have and how bad they are.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can ease swelling and pain. Your doctor can prescribe doses of ibuprofen or naproxen sodium that are strong enough to help with your RA symptoms.

Corticosteroid medications like prednisone can lessen joint damage, pain, and swelling. Your doctor may give you this steroid for serious symptoms, then gradually lower the dose until you don’t need it anymore. You can get it as a shot or as a pill.

Disease-modifying antirheumatic drugs (DMARDs) can slow down RA in your body. Studies have shown that your symptoms may get better if you start taking them soon after your diagnosis. Your doctor may give you hydroxychloroquine (Plaquenil), leflunomide (Arava), methotrexate, or sulfasalazine (Azulfidine).

Biologic agents are a stronger type of DMARDs that your doctor may prescribe when nonbiologic ones don't relieve your symptoms. They relieve the inflammation that damages tissue and joint issues. But this type of drug could make you more likely to get an infection or a blood clot in your lungs. Doctors often prescribe them along with a nonbiologic DMARD.

Therapy. You might see a physical or occupational therapist to learn exercises to help with your RA. They’ll teach you how to keep your joints flexible and may show you more comfortable ways to do daily tasks.

Surgery. Sometimes, medications don’t do enough to stop joint damage. Your doctor may suggest surgery as well. It could range from removal of inflamed joint lining (synovium) to a complete joint replacement. Surgery can enable you to use your damaged joint again as well as relieve pain.

Talk to your doctor to see which RA remedy is best for your symptoms and type of rheumatoid arthritis.