Rheumatoid arthritis (RA) is a chronic (long-lasting) autoimmune disease that mostly affects joints. RA occurs when the immune system, which normally helps protect the body from infection and disease, attacks its own tissues. The disease causes pain, swelling, stiffness, and loss of function in joints.
Additional features of rheumatoid arthritis can include the following:
It affects the lining of the joints, which damages the tissue that covers the ends of the bones in a joint.
RA often occurs in a symmetrical pattern, meaning that if one knee or hand has the condition, the other hand or knee is often also affected.
It can affect the joints in the wrists, hands, elbows, shoulders, feet, spine, knees, and jaw.
RA may cause fatigue, occasional fevers, and a loss of appetite.
RA may cause medical problems outside of the joints, in areas such as the heart, lungs, blood, nerves, eyes, and skin.
Fortunately, current treatments can help people with the disease to lead productive lives.
Who Gets Rheumatoid Arthritis?
You are more likely to get rheumatoid arthritis if you have certain risk factors. These include:
Age. The disease can happen at any age; however, the risk for developing rheumatoid arthritis increases with older age. Children and younger teenagers may be diagnosed with juvenile idiopathic arthritis, a condition related to rheumatoid arthritis.
Sex. Rheumatoid arthritis is more common among women than men. About two to three times as many women as men have the disease. Researchers think that reproductive and hormonal factors may play a role in the development of the disease for some women.
Family history and genetics. If a family member has RA, you may be more likely to develop the disease. There are several genetic factors that slightly increase the risk of getting RA.
Smoking. Research shows that people who smoke over a long period of time are at an increased risk of getting rheumatoid arthritis. For people who continue to smoke, the disease may be more severe.
Obesity. Some research shows that being obese may increase your risk for the disease as well as limit how much the disease can be improved.
Periodontitis. Gum disease may be associated with developing RA.
Lung diseases. Diseases of the lungs and airways may also be associated with developing RA.
Symptoms of Rheumatoid Arthritis
Common symptoms of rheumatoid arthritis include:
RA affects people differently. In some people, RA starts with mild or moderate inflammation affecting just a few joints. However, if it is not treated or the treatments are not working, RA can worsen and affect more joints. This can lead to more damage and disability.
At times, RA symptoms worsen in “flares” due to a trigger such as stress, environmental factors (such as cigarette smoke or viral infections), too much activity, or suddenly stopping medications. In some cases, there may be no clear cause.
The goal of treatment is to control the disease so it is in remission or near remission, with no signs or symptoms of the disease.
Rheumatoid arthritis can cause other medical problems, such as:
Joint pain at rest and when moving, along with tenderness, swelling, and warmth of the joint.
Joint stiffness that lasts longer than 30 minutes, typically after waking in the morning or after resting for a long period of time.
Joint swelling that may interfere with daily activities, such as difficulty making a fist, combing hair, buttoning clothes, or bending knees.
Fatigue – feeling unusually tired or having low energy.
Occasional low-grade fever.
Loss of appetite.
Rheumatoid arthritis can happen in any joint; however, it is more common in the wrists, hands, and feet. The symptoms often happen on both sides of the body, in a symmetrical pattern. For example, if you have RA in the right hand, you may also have it in the left hand.
RA affects people differently. In some people, RA starts with mild or moderate inflammation affecting just a few joints. However, if it is not treated or the treatments are not working, RA can worsen
At times, RA symptoms worsen in “flares” due to a trigger such as stress, environmental factors (such as cigarette smoke or viral infections), too much activity, or suddenly stopping medications. In some cases, there may be no clear cause.
The goal of treatment is to control the disease so it is in remission or near remission, with no signs or symptoms of the disease.
Rheumatoid arthritis can cause other medical problems, such as:
Rheumatoid nodules that are firm lumps just below the skin, typically on the hands and elbows.
Anemia due to low red blood cell counts.
Neck pain.
Dry eyes and mouth.
Inflammation of the blood vessels, the lung tissue, airways, the lining of the lungs, or the sac enclosing the heart.
Lung disease, characterized by scarring and inflammation of the lungs that can be severe in some people with RA.
Causes of Rheumatoid Arthritis
Researchers do not know what causes the immune system 7to turn against the body’s joints and other tissues. Studies show that a combination of the following factors may lead to the disease:
Genes. Certain genes that affect how the immune system works may lead to rheumatoid arthritis. However, some people who have these genes never develop the disease. This suggests that genes are not the only factor in the development of RA. In addition, more than one gene may determine who gets the disease and how severe it will become.
Environment. Researchers continue to study how environmental factors such as cigarette smoke may trigger rheumatoid arthritis in people who have specific genes that also increase their risk. In addition, some factors such as inhalants, bacteria, viruses, gum disease, and lung disease may play a role in the development of RA.
Sex hormones. Researchers think that sex hormones may play a role in the development of rheumatoid arthritis when genetic and environmental factors also are involved. Studies also show:
Women are more likely than men to develop rheumatoid arthritis.
The disease may improve during pregnancy and flare after pregnancy.
Tests and Diagnosis
Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis.
During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also check your reflexes and muscle strength.
Blood tests
People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinate d peptide (anti-CCP) antibodies.
Treatment and Drugs
There is no cure for rheumatoid arthritis. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage.
Occupational and physical therapy can teach you how to protect your joints. If your joints are severely damaged by rheumatoid arthritis, surgery may be necessary.
Medications
Many drugs used to treat rheumatoid arthritis have potentially serious side effects. Doctors typically prescribe medications with the fewest side effects first. You may need stronger drugs or a combination of drugs if your disease progresses.
NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.
Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).
Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan) and tocilizumab (Actemra). Tofacitinib (Xeljanz), a new, synthetic DMARD, is also available in the U.S.
These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections.
Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.