Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that is chronic (ongoing). It occurs in the joints on both sides of your body, which makes it different from other types of arthritis. You may have symptoms of pain and inflammation in your:

  • Fingers.
  • Hands.
  • Wrists
  • Knees
  • Ankles.
  • Feet.
  • Toes.

Uncontrolled inflammation damages cartilage, which normally acts as a “shock absorber” in your joints. In time, this can deform your joints. Eventually, your bone itself erodes. This can lead to the fusion of your joint (an effort of your body to protect itself from constant irritation).

Specific cells in your immune system (your body’s infection-fighting system) aid this process. These substances are produced in your joints but also circulate and cause symptoms throughout your body. In addition to affecting your joints, rheumatoid arthritis sometimes affects other parts of your body, including your:

  • Skin.
  • Eyes.
  • Mouth.
  • Lungs.
  • Heart.

Who gets rheumatoid arthritis?

Rheumatoid arthritis affects more than 1.3 million people in the United States. It’s 2.5 times more common in people designated female at birth than in people designated male at birth.

What’s the age of onset for rheumatoid arthritis?

RA usually starts to develop between the ages of 30 and 60. But anyone can develop rheumatoid arthritis. In children and young adults — usually between the ages of 16 and 40 — it’s called young-onset rheumatoid arthritis (YORA). In people who develop symptoms after they turn 60, it’s called later-onset rheumatoid arthritis (LORA).

SYMPTOMS AND CAUSES

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis affects everyone differently. In some people, joint symptoms develop over several years. In other people, rheumatoid arthritis symptoms progress rapidly. Many people have time with symptoms (flares) and then time with no symptoms (remission).

Symptoms of rheumatoid arthritis include:

  • Pain, swelling, stiffness and tenderness in more than one joint.
  • Stiffness, especially in the morning or after sitting for long periods.
  • Pain and stiffness in the same joints on both sides of your body.
  • Fatigue (extreme tiredness).
  • Weakness.
  • Fever.

Does rheumatoid arthritis cause fatigue?

Everyone’s experience of rheumatoid arthritis is a little different. But many people with RA say that fatigue is among the worst symptoms of the disease.

Living with chronic pain can be exhausting. And fatigue can make it more difficult to manage your pain. It’s important to pay attention to your body and take breaks before you get too tired.

What are rheumatoid arthritis flare symptoms?

The symptoms of a rheumatoid arthritis flare aren’t much different from the symptoms of rheumatoid arthritis. But people with RA have ups and downs. A flare is a time when you have significant symptoms after feeling better for a while. With treatment, you’ll likely have periods of time when you feel better. Then, stress, changes in weather, certain foods or infections trigger a period of increased disease activity.

Although you can’t prevent flares altogether, there are steps you can take to help you manage them. It might help to write your symptoms down every day in a journal, along with what’s going on in your life. Share this journal with your rheumatologist, who may help you identify triggers. Then you can work to manage those triggers.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is unknown. Researchers think it’s caused by a combination of genetics, hormones and environmental factors.

Normally, your immune system protects your body from disease. With rheumatoid arthritis, something triggers your immune system to attack your joints. An infection, smoking or physical or emotional stress may be triggering.

Is rheumatoid arthritis genetic?

Scientists have studied many genes as potential risk factors for RA. Certain genetic variations and non-genetic factors contribute to your risk of developing rheumatoid arthritis. Non-genetic factors include sex and exposure to irritants and pollutants.

People born with variations in the human leukocyte antigen (HLA) genes are more likely to develop rheumatoid arthritis. HLA genes help your immune system tell the difference between proteins your body makes and proteins from invaders like viruses and bacteria.

What are the risk factors for developing rheumatoid arthritis?

There are several risk factors for developing rheumatoid arthritis. These include:

  • Family history: You’re more likely to develop RA if you have a close relative who also has it.
  • Sex: Women and people designated female at birth are two to three times more likely to develop rheumatoid arthritis.
  • Smoking: Smoking increases a person’s risk of rheumatoid arthritis and makes the disease worse.
  • Obesity: Your chances of developing RA are higher if you have obesity.

DIAGNOSIS AND TESTS

How is rheumatoid arthritis diagnosed?

Your healthcare provider may refer you to a physician who specializes in arthritis (rheumatologist). Rheumatologists diagnose people with rheumatoid arthritis based on a combination of several factors. They’ll do a physical exam and ask you about your medical history and symptoms. Your rheumatologist will order blood tests and imaging tests.

The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid arthritis. These may include:

  • Erythrocyte sedimentation rate (ESR) or “sed rate” confirms inflammation in your joints.
  • C-reactive protein (CRP).
  • About 80% of people with RA test positive for rheumatoid factor (RF).
  • About 60% to 70% of people living with rheumatoid arthritis have antibodies to cyclic citrullinated peptides (CCP) (proteins).

Your rheumatologist may order imaging tests to look for signs that your joints are wearing away. Rheumatoid arthritis can cause the ends of the bones within your joints to wear down. The imaging tests may include:

In some cases, your provider may watch how you do over time before making a definitive diagnosis of rheumatoid arthritis.

What are the diagnostic criteria for rheumatoid arthritis?

Diagnostic criteria are a set of signs, symptoms and test results your provider looks for before telling you that you’ve got rheumatoid arthritis. They’re based on years of research and clinical practice. Some people with RA don’t have all the criteria. Generally, though, the diagnostic criteria for rheumatoid arthritis include:

  • Inflammatory arthritis in two or more large joints (shoulders, elbows, hips, knees and ankles).
  • Inflammatory arthritis in smaller joints.
  • Positive biomarker tests like rheumatoid factor (RF) or CCP antibodies.
  • Elevated levels of CRP or an elevated sed rate.
  • Your symptoms have lasted more than six weeks.

MANAGEMENT AND TREATMENT

What are the goals of treating rheumatoid arthritis?

The most important goal of treating rheumatoid arthritis is to reduce joint pain and swelling. Doing so should help maintain or improve joint function. The long-term goal of treatment is to slow or stop joint damage. Controlling joint inflammation reduces your pain and improves your quality of life.

How is rheumatoid arthritis treated?

Joint damage generally occurs within the first two years of diagnosis, so it’s important to see your provider if you notice symptoms. Treating rheumatoid arthritis in this “window of opportunity” can help prevent long-term consequences.

Treatments for rheumatoid arthritis include lifestyle changes, therapies, medicine and surgery. Your provider considers your age, health, medical history and how bad your symptoms are when deciding on a treatment.

What medications treat rheumatoid arthritis?

Early treatment with certain drugs can improve your long-term outcome. Combinations of drugs may be more effective than, and appear to be as safe as, single-drug therapy.

There are many medications to decrease joint pain, swelling and inflammation, and to prevent or slow down the disease. Medications that treat rheumatoid arthritis include:

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs decrease pain and inflammation. They include products like:

  • Ibuprofen (Advil®, Motrin®).
  • Naproxen (Aleve®).
  • Aspirin.

COX-2 inhibitors

COX-2 inhibitors are another kind of NSAID. They include products like celecoxib (Celebrex®). COX-2 inhibitors have fewer bleeding side effects on your stomach than typical NSAIDs.

Corticosteroids

Corticosteroids, also known as steroids, also can help with pain and inflammation. They include prednisone and cortisone.

Disease-modifying antirheumatic drugs (DMARDs)

Unlike other NSAIDs, DMARDs actually can slow the disease process by modifying your immune system. Your provider may prescribe DMARDs alone and in combination with steroids or other drugs. Common DMARDs include:

  • Methotrexate (Trexall®).
  • Hydroxychloroquine (Plaquenil®).
  • Sulfasalazine (Azulfidine®).
  • Leflunomide (Arava®).

Janus kinase (JAK) inhibitors

JAK inhibitors are another type of DMARD. Rheumatologists often prescribe JAK inhibitors for people who don’t improve taking methotrexate alone. These products include:

  • Tofacitinib (Xeljanz®).
  • Baracitinib (Olumiant®).

Biologics

If you don’t respond well to DMARDs, your provider may prescribe biologic response agents (biologics). Biologics target the molecules that cause inflammation in your joints. Providers think biologics are more effective because they attack the cells at a more specific level. These products include:

  • Etanercept (Enbrel®).
  • Infliximab (Remicade®).
  • Adalimumab (Humira®).
  • Anakinra (Kinaret®).
  • Abatacept (Orencia®).
  • Rituximab (Rituxan®).
  • Certolizumab (Cimzia®).
  • Golimumab (Simponi®).
  • Tocilizumab (Actemra®).

Biologics tend to work rapidly — within two to six weeks. Your provider may prescribe them alone or in combination with a DMARD like methotrexate.

What is the safest drug for rheumatoid arthritis?

The safest drug for rheumatoid arthritis is one that gives you the most benefit with the least amount of negative side effects. This varies depending on your health history and the severity of your RA symptoms. Your healthcare provider will work with you to develop a treatment program. The drugs your healthcare provider prescribes will match the seriousness of your condition.

It’s important to meet with your healthcare provider regularly. They’ll watch for any side effects and change your treatment, if necessary. Your healthcare provider may order tests to determine how effective your treatment is and if you have any side effects.

Will changing my diet help my rheumatoid arthritis?

When combined with the treatments and medications your provider recommends, changes in diet may help reduce inflammation and other symptoms of RA. But it won’t cure you. You can talk with your doctor about adding good fats and minimizing bad fats, salt and processed carbohydrates. No herbal or nutritional supplements, like collagen, can cure rheumatoid arthritis. These dietary changes are safer and most successful when monitored by your rheumatologist.

But there are lifestyle changes you can make that may help relieve your symptoms. Your rheumatologist may recommend weight loss to reduce stress on inflamed joints.

People with rheumatoid arthritis also have a higher risk of coronary artery disease. High blood cholesterol (a risk factor for coronary artery disease) can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid to reach a desirable cholesterol level.

When is surgery used to treat rheumatoid arthritis?

Surgery may be an option to restore function to severely damaged joints. Your provider may also recommend surgery if your pain isn’t controlled with medication. Surgeries that treat RA include:

  • Knee replacement.
  • Hip replacement.
  • Other surgeries to correct a deformity.

OUTLOOK / PROGNOSIS

What is the prognosis (outlook) for people who have rheumatoid arthritis?

Although there’s no cure for rheumatoid arthritis, there are many effective methods for decreasing your pain and inflammation and slowing down your disease process. Early diagnosis and effective treatment are very important.

What types of lifestyle changes can help with rheumatoid arthritis?

Having a lifelong illness like rheumatoid arthritis may make you feel like you don’t have much control over your quality of life. While there are aspects of RA that you can’t control, there are things you can do to help you feel the best that you can.

Such lifestyle changes include:

Rest

When your joints are inflamed, the risk of injury to your joints and nearby soft tissue structures (such as tendons and ligaments) is high. This is why you need to rest your inflamed joints. But it’s still important for you to exercise. Maintaining a good range of motion in your joints and good fitness overall are important in coping with RA.

Exercise

Pain and stiffness can slow you down. Some people with rheumatoid arthritis become inactive. But inactivity can lead to a loss of joint motion and loss of muscle strength. These, in turn, decrease joint stability and increase pain and fatigue.

Regular exercise can help prevent and reverse these effects. You might want to start by seeing a physical or occupational therapist for advice about how to exercise safely. Beneficial workouts include:

  • Range-of-motion exercises to preserve and restore joint motion.
  • Exercises to increase strength.
  • Exercises to increase endurance (walking, swimming and cycling).

FREQUENTLY ASKED QUESTIONS

What are the early signs of rheumatoid arthritis?

Early signs of rheumatoid arthritis include tenderness or pain in small joints like those in your fingers or toes. Or you might notice pain in a larger joint like your knee or shoulder. These early signs of RA are like an alarm clock set to vibrate. It might not always been enough to get your attention. But the early signs are important because the sooner you’re diagnosed with RA, the sooner your treatment can begin. And prompt treatment may mean you are less likely to have permanent, painful joint damage.

What is early stage rheumatoid arthritis?

Providers sometimes use the term “early rheumatoid arthritis” to describe the condition in people who’ve had symptoms of rheumatoid arthritis for fewer than six months.

What are the four stages of rheumatoid arthritis?

  • Stage 1: In early stage rheumatoid arthritis, the tissue around your joint(s) is inflamed. You may have some pain and stiffness. If your provider ordered X-rays, they wouldn’t see destructive changes in your bones.
  • Stage 2: The inflammation has begun to damage the cartilage in your joints. You might notice stiffness and a decreased range of motion.
  • Stage 3: The inflammation is so severe that it damages your bones. You’ll have more pain, stiffness and even less range of motion than in stage 2, and you may start to see physical changes.
  • Stage 4: In this stage, the inflammation stops but your joints keep getting worse. You’ll have severe pain, swelling, stiffness and loss of mobility.

What’s the normal sed rate for rheumatoid arthritis?

Sed rate (erythrocyte sedimentation rate, also known as ESR) is a blood test that helps detect inflammation in your body. Your healthcare provider may also use this test to watch how your RA progresses. Normal sed rates are as follows:

People designated male at birthErythrocyte sedimentation rate
< 50 years old≤ 15 mm/hr
> 50 years old≤ 20 mm/hr
People designated female at birth
< 50 years old≤ 20 mm/hr
> 50 years old≤ 30 mm/hr

In rheumatoid arthritis, your sed rate is likely higher than normal. To take part in clinical trials related to rheumatoid arthritis, you usually need an ESR of ≥ 28 mm/hr. With treatment, your sed rate may decrease. If you reach the normal ranges listed above, you may be in remission.

What is the difference?

Rheumatoid arthritis vs. osteoarthritis

Rheumatoid arthritis and osteoarthritis are both common causes of pain and stiffness in joints. But they have different causes. In osteoarthritis, inflammation and injury break down your cartilage over time. In rheumatoid arthritis, your immune system attacks the lining of your joints.

Rheumatoid arthritis vs. gout

Rheumatoid arthritis and gout are both painful types of arthritis. Gout symptoms include intense pain, redness, stiffness, swelling and warmth in your big toe or other joints. In gout, uric acid crystals cause inflammation. In rheumatoid arthritis, it’s your immune system that causes joint damage.

Is rheumatoid arthritis a disability?

The Americans with Disabilities Act (ADA) says that a disability is a physical or mental impairment that limits one or more major life activity. If RA impacts your ability to function, you may qualify for disability benefits from the Social Security Administration.

Can rheumatoid arthritis go away?

No, rheumatoid arthritis doesn’t go away. It’s a condition you’ll have for the rest of your life. But you may have periods where you don’t notice symptoms. These times of feeling better (remission) may come and go.

That said, the damage RA causes in your joints is here to stay. If you don’t see a provider for RA treatment, the disease can cause permanent damage to your cartilage and, eventually, your joints. RA can also harm organs like your lung and heart.

@healthqueries.in @daljitghatoura

If you have rheumatoid arthritis, you may feel like you’re on a lifelong roller coaster of pain and fatigue. It’s important to share these feelings and your symptoms with your healthcare provider. Along with X-rays and blood tests, what you say about your quality of life will help inform your treatment. Your healthcare provider will assess your symptoms and recommend the right treatment plan for your needs. Most people can manage rheumatoid arthritis and still do the activities they care about.

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