Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease. With RA, your immune system attacks the lining of your joints, causing inflammation and thickening. This can damage joints over time and cause long-term disability if it’s not treated.
What Are the Symptoms of Rheumatoid Arthritis?
RA has several common symptoms to be aware of. The symptoms may come and go at first but tend to get progressively worse over time without treatment.
The most common early symptoms include:
- Joint pain and swelling. The pain often affects smaller joints first, like those in your hands and feet, before progressing to wrists, elbows, knees, hips, shoulders, and neck.
- Stiffness and trouble moving. Joint inflammation causes stiffness that’s usually worse in the morning or after long periods of inactivity.
- Fatigue. The inflammation can make you feel chronically tired.
- Low fever. Mild fevers of 100 to 102°F are common with active RA inflammation.
As RA gets worse, you may also notice:
- Loss of appetite
- Rheumatoid nodules or lumps under your skin
- Eye pain or redness if it causes eye inflammation
- Numbness or tingling in your extremities
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What Causes Rheumatoid Arthritis?
Experts don’t know exactly what causes some people’s immune systems to attack the joints but suspect it’s a combination of genetic and environmental factors.
Risk factors that make you more likely to develop rheumatoid arthritis include:
- Family history. You have a greater risk of developing RA if you have a close family member with the condition.
- Age. Onset most often occurs between ages 30-50 but can start at any age.
- Sex. Women get RA more often than men.
- Smoking. Lighting up increases your risk of RA and causes more severe symptoms.
- Obesity. Carrying excess weight raises the risk of developing RA.
- Environmental exposures. Things like pollution, chemicals, bacteria, and viruses are possible RA triggers.
Rheumatoid Arthritis Diagnosis
There’s no single test to definitively diagnose rheumatoid arthritis. Doctors use a combination of factors, including your signs, symptoms, physical exam, imaging, and blood tests to make a diagnosis.
Signs your doctor checks for include:
- Number of painful or swollen joints
- Which joints are affected
- Symmetry of symptoms (both sides of body affected)
- Pattern of joint involvement
Typical RA causes swelling in the same joints on both sides at once, especially smaller joints toward the ends of your arms and legs.
Blood tests look for:
- Rheumatoid factor antibodies
- Anti-CCP antibodies
- Erythrocyte sedimentation rate (ESR) to detect inflammation
- C-reactive protein (CRP) levels to check for inflammation
Imaging tests like X-rays and MRIs check for:
- Bone damage
- Cartilage loss
- Inflammation in synovial tissue lining joints
How Is Rheumatoid Arthritis Treated?
RA treatment focuses on relieving pain, reducing inflammation, preventing joint damage, and achieving remission. Treatment plans are tailored to each person’s symptoms and how well their RA is controlled.
Medications Used to Treat RA Include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) to relieve pain
- Disease-modifying antirheumatic drugs (DMARDs) that slow disease by suppressing your overactive immune system
- Biologic drugs or biologics that target parts of the immune system causing inflammation
- Corticosteroids like prednisone to quickly reduce swelling while waiting for DMARDs and biologics to take effect
Other Therapies:
- Hand splints, braces, or custom shoes
- Assistive devices for help with daily tasks
- Physical/occupational therapy
- Surgery for badly damaged joints
Getting RA into remission should be the initial goal. This is when you have no disease activity. Long-term treatment aims to manage symptoms, ensure remission, prevent joint damage, and maintain ability.
What Is the Outlook for People with Rheumatoid Arthritis?
Thanks to expanding treatment options over the last two decades, most people with RA can live full and productive lives. Early, aggressive diagnosis and treatment to reach remission optimizes outcomes.
With proper management:
- Joint damage progression can be minimized
- Most can continue working with adaptations as needed
- Only 10% develop significant disability after 10 years
Without adequate treatment or with delayed treatment:
- Joint damage can happen rapidly in the first two years
- Severe loss of joint function may occur
- Risk goes up for anxiety, depression and heart/lung disease
While less common today, RA can still cause serious health complications:
- Bone erosion
- Joint deformities
- Increased risk of heart attack, stroke, infections
Risk Factors for Developing Rheumatoid Arthritis
What makes some people more prone to getting rheumatoid arthritis (RA) while others don’t? Research shows that certain risk factors raise your chances of developing RA.
Genetics
If RA runs in your family, you have a greater risk of getting it too. Specific genes called HLA genes that regulate the immune system are associated with RA development.
Having a first-degree relative with RA raises your risk, such as:
- Parent: 2 to 3 times higher
- Sibling: 8 to 10 times higher
- Identical twin: 15 times or more
But genes aren’t the whole picture or everyone with a family history would get RA. Outside environmental triggers also play a role.
Age
Onset of rheumatoid arthritis typically happens at ages 30 to 50 years old but can start at any age. Rarer juvenile rheumatoid arthritis affects kids under age 16.
Women tend to develop RA at younger ages than men on average. Their peak incidence rate hits at age 40 to 50 while the typical onset for affected men is ages 60 to 75.
Sex
For reasons not fully understood, rheumatoid arthritis is two to three times more common in women than men. This gender disparity may come down to differences in hormones and their effect on the development of autoimmunity.
The female to male diagnosis ratio has increased over the last 50 years from about 2-to-1 up to 3-to-1 today. Researchers speculate women’s changing exposures to risk factors like smoking may play a role.
Smoking
Lighting up cigarettes raises your odds of getting rheumatoid arthritis and leads to a more severe course of RA once you have it.
Specifically:
- Smokers are up to 4x more likely to develop RA
- Increased severity: more joint damage, more disability, lower chance of remission
- Each year of smoking = 2 additional years of RA symptoms
- Being a former smoker still leaves an elevated risk
Experts think smoking may induce changes in cells, make the body prone to recognizing itself as foreign, and set off autoimmune responses like RA.
Obesity
There’s a clear tie between being overweight and increased risk of rheumatoid arthritis (RA). But shedding pounds can lower your risk back down.
In one study of women:
- Obese: nearly 2x more prone to get RA
- Overweight: 1.5x greater risk
- Normal: lowest risk
- Losing weight = lower RA risk over time
Body fat likely plays a role in promoting chronic inflammation that can trigger immune system dysfunction and joint damage over time.
Environmental Factors
It’s suspected that something in the environment like an infection, bacteria, virus, or other exposure prompts RA to develop in those predisposed. But no specific triggering agent has been definitively identified yet.
Still, certain exposures have been possibly linked to RA including:
- Periodontal disease
- Smoking and secondhand smoke
- Air pollution exposures
- Lower socioeconomic status
- Silica mineral exposure
- Pesticide exposure
- Traffic emissions
Symptoms of Rheumatoid Arthritis Flares
Many people with rheumatoid arthritis (RA) experience flares where symptoms suddenly worsen. Knowing potential flare symptoms helps you recognize them early so you can adjust treatment to get inflammation back under control.
Common symptoms that your RA is flaring include:
- Severe joint pain and swelling
- Extreme stiffness lasting over 1 hour
- New swelling in previously unaffected joints
- More joint tenderness or warmth
- Increased weakness and fatigue
- Firm lumps (rheumatoid nodules) under skin
- Low-grade fever (under 102°F)
Flare triggers vary by person but often include:
- Infection
- Weather changes
- Increased stress
- Changes to treatment routine
- Overusing joints through repetitive motions
It’s crucial to alert your doctor if you experience an RA flare so they can determine if your medications need adjusting to better control disease activity. The sooner flares are treated, the lower the risk of permanent joint damage accumulating.
Is Remission Possible with Rheumatoid Arthritis?
Thanks to expanding treatment options, remission is now an achievable goal for many people with rheumatoid arthritis (RA). But what is remission exactly?
In rheumatoid arthritis, remission means:
- Little to no signs and symptoms of inflammatory disease activity
- No progression of bone/cartilage damage
- Reduction in disability
Complete remission means all symptoms are gone with no flare-ups. A good partial remission shows minimal disease activity with manageable flares.
Diagnosing Rheumatoid Arthritis Remission
Doctors determine if your RA is in remission based on:
Clinical factors:
- Number of tender/swollen joints
- Amount of morning stiffness
- Flare frequency
- Need to escalate medication
Blood tests:
- Normal inflammatory markers (ESR, CRP)
- Low rheumatoid factor or anti-CCP antibodies
Imaging tests:
- No evidence of new bone damage
- No active synovitis (joint inflammation)
Reaching remission is crucial early in RA to limit cumulative joint destruction and disability. A sustained remission helps ensure you can keep doing daily tasks pain-free.
How Is Remission Achieved?
Starting aggressive treatment as soon as possible offers the best shot at RA remission before extensive damage occurs.
Strategies to reach remission include:
- Swiftly starting and optimizing DMARDs/biologics
- Closely monitoring disease activity
- Using corticosteroid joint injections to bridge the gap until medications fully take effect
- Making lifestyle changes – quit smoking, lose excess weight, eat anti-inflammatory foods, practice joint protection
Staying in remission long-term tends to need ongoing medication treatment even if you feel fine. Relapses happen in most people the longer you have RA if drugs are stopped.
Living with Rheumatoid Arthritis
Learning to live with rheumatoid arthritis (RA) well takes some trial-and-error over time to balance rest and activity, develop helpful habits, use medications properly, and know when to seek guidance from your rheumatology providers.
Finding Your Limits
Most people need to adjust their routines at least somewhat after an RA diagnosis. Flares and symptoms that wax and wane frequently make energy and stamina fluctuate day-to-day.
Keeping a symptom journal can help you spot patterns in what activities reliably worsen or ease your inflammation and pain. Over time, you’ll learn your capacities and limits to stay as active as possible without overtaxing inflamed joints.
Helpful Habits and Home Modifications
Little changes around your home and simple tools can make daily tasks less challenging with RA joint pain and stiffness. Consider trying:
For the kitchen
- Jar opener for tight lids
- Adaptive handles for utensils
- Lightweight pots/pans
- Sit rather than stand for prep
For dressing
- Zipper pulls for clothes
- Elastic shoe laces
- Button hooks
- Replaced small buttons with velcro
For household chores
- Mobility aids like a reacher or long-handled duster
- Sitting cleaning caddies for washing bathtubs/floors
- Hybrid styles combining mops, brooms and dustpans
Making even small adaptations prevents using your sore joints in ways likely to worsen pain or cause injury. Protecting your joints helps you preserve strength and movement.
Tips for Talking To Your Doctor About RA
Managing rheumatoid arthritis requires an ongoing partnership with your rheumatologist. Over time, you’ll get to know your normal pain patterns versus when things seem to be getting worse in ways that warrant a treatment change.
Come prepared to appointments with:
- List of all symptoms you’ve had lately
- Notes on symptom changes
- Current medications/supplements/treatments used
- Questions about possible medication adjustments or additions
Clear communication with your providers helps optimize treatment. Don’t downplay symptoms. Being fully honest helps your doctor determine if your condition is stable or requires modifications. The sooner flares are addressed, the better.
How Does Rheumatoid Arthritis Cause Joint Damage?
The underlying autoimmune inflammation of rheumatoid arthritis (RA) is what gradually destroys cartilage and bone inside joints over time leading to deformities and disability. Understanding this process helps motivate early treatment.
The Autoimmune Attack
With RA, the body’s defenses mistakenly identify tissues in the joint lining and cartilage as “foreign” and launch an attack against them. Immune cells flood to the joints triggering significant inflammation.
This chronic inflammatory state:
- Redness, warmth, swelling, and fluid build-up
- Stiff, throbbing joint pain
- Loss of motion and flexibility
Some people have autoantibodies like rheumatoid factor and anti-CCP antibodies underlying this abnormal immune response.
Cartilage Breakdown
The inflamed synovium (joint lining) grows thicker and begins to invade the cartilage covering the bone surface. Enzymes released eat away cartilage like termites munching wood over time.
Areas where cartilage erodes:
- Narrow joint space visible on x-rays
- Undermines smooth joint function
- Allows inflammation to spread deeper
Bone Damage
With the cartilage cushion destroyed, inflammation progresses deeper. The multiplying synovial cells begin to invade and penetrate bone itself.
Bone complications include:
- Pitting and holes forming
- Erosion around joint perimeter
- Complete loss of bone segments
This cumulative destruction of cartilage and bone is what gradually reshapes joints, fusing bones that normally glide freely leading to permanent deformities.
Why Early Treatment Matters
After just two years of moderate to high disease activity, over 60% of people see beginnings of irreversible joint damage according to radiographic data.
The first 2 years are critical because:
- Joints become rapidly, progressively deformed
- Treatment has best shot to induce remission before major damage
- Disability risk remains even if later treatment controls inflammation
Early optimal treatment is crucial for the best outcomes long-term. Monitoring progression with x-rays identifies when therapy changes are needed.
Coping with Rheumatoid Arthritis Flare Symptoms
Flares of worsening joint pain, fatigue, and stiffness are an unfortunate reality most people with rheumatoid arthritis (RA) face periodically. While adjusting treatments helps over time, flares often continue popping up.
When an RA flare hits, focus first on coping through the bad days so you can get back to routine as soon as possible.
Rest and Protection
Listen when your body says it needs extra rest. Lighten your schedule if you can and put lower priority tasks on hold.
Avoid activities most likely to overtire joints or cause injury during severe flares, especially high impact exercise. Low intensity movement provides benefits without strain.
Comfort Measures
Apply localized heat pads to ease stiffness or discomfort, or ice packs to swollen hot spots. Try pain relieving creams containing menthol or capsaicin on trouble areas. Or ask your doctor about prescribing a topical NSAID gel.
Massage tender points and stretch gently if motion helps ease aching. Consider splinting very painful joints until things calm down.
Stress and Mood Support
Managing the emotional side effects of an RA flare matters too. Relaxation techniques, enjoyable hobbies, and social connection boost coping capacity.
If overwhelming fatigue, pain and loss of function drag your mood down consistently over weeks, discuss antidepressant options with your doctor. Getting flare-ups back under control helps resolve temporary mood dips.
When to Call the Doctor About an RA Flare
Rheumatologists want patients to report flares rapidly so treatment can be adjusted if appropriate before symptoms worsen or joint injury risk rises.
Reach out to your RA doctor right away if:
- Swelling/pain lasts over a week with no improvement
- Most swollen joint count ever recorded
- Symptoms interfere with work, sleep or daily tasks
- Used maximum HTCZ doses without relief
- Fever over 100°F for more than a day
Don’t delay calling when flares are severe or unremitting. Getting inflammation back in check ASAP prevents setbacks.
Rheumatoid Arthritis Treatment Options
Modern rheumatoid arthritis treatment utilizes a range of medications and therapies to limit joint damage from inflammation and help people manage symptoms for the best quality of life possible.
Disease-Modifying Antirheumatic Drugs (DMARDs)
DMARDs work by:
- Suppressing an overactive immune system
- Preventing it from attacking joints
- Controlling underlying disease rather than just relieving symptoms
Because RA is an autoimmune condition, regulating the immune response is crucial to prevent progressive destruction of cartilage and bone over time.
Common DMARDs for RA:
- Methotrexate
- Sulfasalazine
- Leflunomide
- Hydroxychloroquine
Typically people start with methotrexate first. Multiple DMARDs are often used together. It may take 2-6 months for maximum benefits.
Biologic Medications
Biologics (or biologic response modifiers) work by:
- Targeting specific parts of the immune system fueling inflammation
- Blocking inflammatory pathways
Types of biologics used for RA:
- TNF inhibitors – Humira, Enbrel
- IL-6 inhibitors – Actemra, Kevzara
- T cell inhibitors – Orencia
- B cell inhibitors – Rituxan
Biologics offer effectiveness when DMARDs alone aren’t adequately controlling disease activity. They may be used solo or along with methotrexate or other DMARDs.
Corticosteroids
Corticosteroids like prednisone directly counter inflammation. They may be used short-term while waiting for slower-acting RA drugs to reach full effect. Steroids come as:
- Pills
- Injections into joints, tendons or bursae
- Topical creams
Long-term oral steroids increase infection risk and other side effects at higher doses. Use is limited to the lowest effective amount for shortest time possible.
Surgery
Severe joint damage that no longer responds to medications may ultimately require surgical intervention. RA surgery can involve:
- Removal of inflamed synovial tissue
- Joint fusion to stabilize bones
- Total joint replacements with prosthetics
Surgeries reduce pain while optimizing remaining mobility. With modern implants, joints can often function many years after replacement.