Rheumatoid Arthritis

What is rheumatoid arthritis? 

Rheumatoid arthritis (RA) is an autoimmune disease where your immune system attacks healthy cells in your body and causes inflammation. It’s the most common type of inflammatory arthritis.

Rheumatoid arthritis is different from osteoarthritis, which is the “wear-and-tear” type of arthritis that many people get as they get older. People can get rheumatoid arthritis at any age, but it most commonly appears between 30 to 50 years of age. Women are affected more often than men.

RA causes swelling in the lining of your joints, which can lead to joint pain, joint damage and decreased flexibility and deformity, most often in the small joints of the hands, wrists, fingers, ankles and feet. 

As the disease progresses, it can spread to larger joints, such as the knees, elbows, shoulders, hips, spine and jaw. The inflammation from RA can also affect other parts of the body, such as the eyes, heart, skin, blood vessels and lungs. 

RA is a chronic condition, which means it can’t be cured. However, early diagnosis and proper treatment can help to control symptoms and make long-term complications less likely.

What causes rheumatoid arthritis?

We know that when you have RA, your body’s immune system mistakes healthy cells for cells it’s designed to fight, such as viruses and bacteria, and attacks them with inflammatory substances. 

With RA, the immune system targets a lining around joints called the synovium, which then becomes thickened and releases chemicals that damage the cartilage and bone. Over time, the muscles, ligaments and tendons around joints can weaken as well.

It’s not clear why your body’s immune system reacts this way. It’s possible that a combination of genetics, environmental factors, stress or viral or bacterial infections can trigger RA. Your immune system could be reacting for years before you notice any symptoms. 

Who is more likely to get rheumatoid arthritis?

While we don’t know exactly what causes RA, a number of risk factors increase your chances of developing rheumatoid arthritis. You’re at increased risk if you are:

• Middle-aged or older. According to the American College of Rheumatology, most people develop rheumatoid arthritis between ages 30 and 50, though it can strike at any age.
• Female. Women are two to three times more likely to develop RA than men, and it is likely that sex hormones contribute to the risk of RA.
• Related to someone with RA. You’re more likely to develop RA if a close family member has it.
• Born with certain genetic factors. You can be born with genes that make it more likely that you’ll develop RA and that your symptoms will be worse. 
• A smoker. Smoking can both increase your risk and make the condition worse. 
• Overweight. If you have a body mass index (BMI) of 30 or higher, your risk of RA is increased, and your risk goes up the more overweight you are.
• Exposed to certain factors as a child. You're at higher risk if your mother smoked or if you have less than a high school education (although the causality is unknown).
• Have gum or lung disease due to inflammation.

Rheumatoid arthritis symptoms

Some people develop RA symptoms over a short time, while in others they can take years to progress. The symptoms of RA can come and go with flares and remission. Flares can last for days, weeks or months.

Signs and symptoms of rheumatoid arthritis include:

• Tenderness, swelling, stiffness, pain or aching in more than one joint, usually in the small joints in your hands and/or feet at first.  In RA, symptoms last for more than six weeks.
• Symptoms on both sides of your body, such as both hands, wrists and knees. (In other types of arthritis, you usually have symptoms on only one side.)
• Joints that feel warm and look red and swollen.
• Stiffness that’s worse when you wake up or when you’ve been still for a while.
• Fatigue.
• Weakness.
• Weight loss and loss of appetite.

How is rheumatoid arthritis diagnosed?

If you have symptoms of RA, your doctor may recommend that you see a rheumatologist, a doctor who specializes in diagnosing and treating arthritis. Tell your doctor about all your symptoms even if they don’t seem related, since RA can affect different parts of your body.

Getting the right diagnosis is crucial because other inflammatory joint diseases can have similar symptoms to RA, especially in its early stages. Your doctor may observe your symptoms over time before diagnosing RA.

Diagnosing RA can include:

• A medical history, where your doctor will ask about your symptoms and any family history of RA or autoimmune disease.
• A physical exam, where your doctor will check your joints and other parts of your body for signs of inflammation.
• Imaging tests such as X-rays and ultrasound, which may be used to evaluate how severe the disease is and if any damage has occurred.
• Blood tests to measure erythrocyte sedimentation rate (ESR), C-reactive protein, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
• Joint aspiration to look for other causes of inflammation, such as infection or gout.

If you have symptoms of RA, seek care promptly. Starting treatment within six months of diagnosis can help minimize long term joint damage.

How is rheumatoid arthritis treated?

People sometimes ask how to cure rheumatoid arthritis permanently. While that’s not possible, you can treat rheumatoid arthritis in ways that reduce pain, slow or stop progression, keep the condition in remission as much as possible and reduce complications.

Your rheumatologist or health care provider will want to control the inflammation quickly and keep it as low as possible. They can work with you to find a treatment plan that works. The goal is to minimize any signs or symptoms of the condition.

Medication options include:

• Nonsteroidal inflammatory drugs (NSAIDs), which may be used in the short term to reduce pain and inflammation. These include ibuprofen, naproxen, meloxicam and COX-2 inhibitors (celecoxib/Celebrex).
• Disease-modifying antirheumatic drugs (DMARDs), which can help slow RA’s progression and prevent deformity. These include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine and may take a few months before you notice they are working. 
• Biological response modifiers, which can work alongside traditional DMARDs. These may be given as a shot or by infusion into a vein. They include adalimumab (Humira), etanercept (Enbrel), abatacept (Orencia), tocilizumab (Actemra) and rituximab (Rituxan).
• JAK inhibitors, which may be prescribed if DMARDs or biologics don’t work and which can work alongside traditional DMARDs. These include tofacitinib (Xeljanz), baricitinib (Olumiant) and upadacitinib (Rinvoq).
• Corticosteroids such as prednisone and hydrocortisone, which are used to treat pain and inflammation. Because corticosteroids have many side effects, you might take them to alleviate symptoms, but their use is often limited to the short term.

Physical therapists or occupational therapists can work with you to help keep your joints flexible, prevent stress on your joints and keep your muscles strong. You may also benefit from assistive devices that can make it easier to do everyday tasks, such as jar openers, utensils with special grips and doorknob covers. Splints can be used to help protect your joints and prevent joint deformity.

When medical and rehabilitation therapies have been exhausted, surgery can help repair joint damage, reduce pain and make it easier for you to function. Surgical options may not be the best fit for everyone and should be discussed with your doctor. Surgical options to treat rheumatoid arthritis include:

• Removing the joint’s inflamed lining (synovectomy).
• Repairing tendons around your diseased joint.
• Fusing a joint to realign or stabilize it.
• Replacing a joint with a prosthetic (total joint replacement).

Complications from RA

RA can have harmful long-term effects on your health and well-being. People with rheumatoid arthritis are more likely to develop heart disease, and this risk increases for people who are obese. People who are obese often don’t get as much benefit from their treatments as people who are not.

If you have RA, you’re also more likely to develop:

• Joint deformity.
• Rheumatoid nodules, which are hard tissue bumps that that tend to appear on fingers and knuckles, elbows, knees, and forearms. Rarely, they can also form in the eyes, vocal cords and internal organs, such as the lungs.
• Osteoporosis, or weakening of the bones, which can be caused by RA and by the medications used to treat it.
• Heart problems such as blocked or hardened blood vessels or inflammation near your heart.
• Lung disease and lung-tissue scarring that can cause shortness of breath.
• Inflamed blood vessels, which can damage your skin and nerves.
• Low levels of red blood cells, which transport oxygen from the lungs to the body.
• Infections, since RA and medications used to treat RA can suppress your immune system 
• Lymphoma, a type of blood cancer.
• Sjögren’s syndrome, which causes dry eyes and mouth.
• A higher proportion of body fat, even with a normal BMI.

What about RA vs. carpal tunnel syndrome? These are two separate conditions, and you can have either without developing the other. If you do have RA in your wrists, however, the swelling of the joint and tendon lining in the wrist can compress your nerves and cause carpal tunnel syndrome.

RA can affect your life in other ways as well. For example, it can be hard to stay employed if you have RA, especially as the disease gets worse. It’s especially challenging for people with physically demanding jobs to work if they have RA.

Managing RA to improve quality of life 

While you can’t cure RA, you can take the following steps to minimize its impact on your activities and well-being:

• Try to get 150 minutes of physical activity a week. Walking, swimming and biking are good choices. Physical activity classes for people who have RA can be helpful if you’re new to exercising or worried that you’ll make your symptoms worse.
• Consider joining an education program that can help you learn how to live with arthritis.
• Connect with other people who have RA, either in a local support group or online.
• Apply heat or cold to your painful joints. You can also try pain-relieving creams, gels or patches.
• Log your symptoms along with food, activities, weather and what is happening in your life to help identify things that trigger flares.
• Stay up to date on your vaccinations and try to avoid getting sick, since infections can trigger flares.
• Start a smoking cessation program if you smoke.
• Learn and practice stress reduction techniques, since lowering stress can help reduce flare-ups. Meditation, deep breathing, visualization, massage, and acupuncture or acupressure may help.
• Choose a healthy, balanced diet that can help you maintain a healthy body weight. Minimizing the consumption of red meat and following an anti-inflammatory or Mediterrean diet may be beneficial for some RA patients.
• Follow your doctor’s instructions.
• Know your limits and rest when you’re tired.
• Lean on your family and friends for support.

If you’re concerned you might have rheumatoid arthritis, make an appointment with a Banner Health rheumatologist who can evaluate your symptoms, provide a diagnosis and get you started on a treatment plan.