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 (the synovium). 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.
Here’s what you need to know about RA, especially if you or a loved one has just found out that you have it.
Symptoms of Rheumatoid Arthritis
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.
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.
Causes of Rheumatoid Arthritis
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. 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 Rheumatoid Arthritis Affect Your Body?
Immune system cells move from the blood into your joints and the tissue that lines them. This 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 Complications
Effects on the skin
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.
There’s also vasculitis, which is inflammation of the blood vessels. It makes spots on the skin that look like ulcers. When it affects larger arteries, it 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.
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.
Pain in the neck
Rheumatoid arthritis is known to cause 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 your RA.
Some simple exercises might help. Talk to your doctor about the best treatments to help 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.
Rheumatoid arthritis or some of the medications that treat it can make it so you don’t have enough healthy red blood cells, which carry oxygen around your body. This is called anemia. Anemia symptoms include:
- Rapid or uneven heartbeat
- Shortness of breath
- 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.
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 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.
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 exactly 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.
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.
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
- 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.
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-rays and blood tests
Blood Tests for Rheumatoid Arthritis
In addition to checking for joint problems, your doctor will also do blood tests to diagnose RA. They will be looking for:
Anemia: People with rheumatoid arthritis may have a low number of red blood cells.
C-reactive protein (CRP): High levels are also 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.
Cyclic citrulline 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.
Rheumatoid Arthritis Treatment
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.
Medications for Rheumatoid Arthritis
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, or naproxen
- Pain relievers that you rub on your skin
- Corticosteroids, like prednisone
- Pain relievers such as acetaminophen (Tylenol)
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 are often the first treatment for RA:
- Methotrexate (Rheumatrex, Trexall), which was first developed to treat cancer
- Hydroxychloroquine (Plaquenil), which was created to treat malaria
- Leflunomide (Arava)
- Sulfasalazine (Azulfidine)
Biologic response modifiers 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 even 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-atto (Amgevita); adalimumab-adaz (Hyrimoz); adalimumab-adbm (Cyltezo); adalimumab-afzb (Abrilada); adalimumab-bwwd (Hadlima); and adalimumab-fkjp (Hulio)
- Anakinra (Kineret)
- Baricitinib (Olumiant)
- Belimumab (Benlysta)
- Certolizumab (Cimzia)
- Etanercept (Enbrel), etanercept-szzs (Erelzi), and etanercept-ykro (Eticovo)
- Golimumab (Simponi, Simponi Aria)
- Infliximab (Remicade), infliximab-dyyb (Inflectra); nfliximab-abda (Renflexis); infliximab-axxq (Avsola); and infliximab-qbtx (IXIFI)
- Rituximab (Rituxan)
- Sarilumab (Kevzara)
- Tocilizumab (Actemra)
- Tofacitinib (Xeljanz)
- Upadacitinib (Rinvoq)
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.
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.