What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that causes joint pain, swelling, and inflammation when the immune system attacks healthy tissue. The specific causes of RA are unknown. RA can affect people at any age, unlike other types of arthritis, which typically occur as people age.

In the early stages of RA, you may experience symptoms in your hands, wrists, or feet. If your condition progresses, inflammation can spread to larger joints, such as the knees and hips. Fatigue is also common, as joint pain and swelling can make you feel tired and weak.

There is no known cure for RA. Some treatments can prevent your condition from progressing, relieve symptoms, and improve your quality of life. That's why early diagnosis and treatment are so important.

Types of Rheumatoid Arthritis

Not all cases of RA look the same. Scientists want to know what causes differences in RA symptoms, disease progression, and outcomes. Research on RA is ongoing, but scientists have identified two factors that can help distinguish different types of RA.

Certain proteins in your blood attack your body. These proteins are called rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCPs). Anti-CCPS are also referred to as anti-citrullinated protein antibodies (ACPAs). Blood tests can determine if you have either of these proteins.

You might hear healthcare providers talk about different types of rheumatoid arthritis, which include:

• Juvenile RA: This type, also called juvenile idiopathic arthritis (JIA), only affects children younger than 16. Children with JIA can experience fever, joint pain, and rash. Proper treatment can ease symptoms.
• Seronegative RA: Your blood has negative RF or does not have anti-CCPs. You still experience the painful symptoms of RA, such as joint pain, stiffness, and swelling. Seronegative RA is less severe and less common than seropositive RA.
• Seropositive RA: Your blood has a positive RF or anti-CCPs. Seropositive RA is the most severe form of RA and accounts for the most cases. People with this type of RA can experience joint damage, rheumatoid nodules (bumps under the skin), and vasculitis (inflamed blood vessels).

Rheumatoid Arthritis Symptoms

Some people with RA may see their symptoms develop slowly. Others experience a rapid disease onset.

The most common RA signs and symptoms include:

• Fatigue or weakness
• Feeling joint pain on both sides of the body
• Injuries that take a long time to heal
• Low-grade fever
• Numbness or tingling in the hands
• Painful aching in the joints
• Stiff, tender, or swollen joints, especially in the morning
• Trouble falling or staying asleep
• Unintentional weight loss or loss of appetite
• Vision problems

RA typically affects the joints. If your condition progresses, you may experience complications that affect the heart, lungs, blood, nerves, eyes, and skin. Sjögren's syndrome, an autoimmune disorder that causes dry eyes and mouth, may also occur. Treatment can slow the disease's progress and limit its impact on daily life.

What Causes Rheumatoid Arthritis?

RA causes your immune system to not function as normal. Your immune system attacks healthy cells, which causes inflammation and painful swelling in your joints. The exact cause of RA is unknown. A combination of genetic and environmental factors can explain why you might develop symptoms.

Here's a breakdown of how scientists believe RA develops:

• You might have inherited a certain gene linked to RA.
• Your immune system can attack healthy cells in your body if you have a gene linked to RA.
• You can experience pain and inflammation once your immune system attacks your body.
• Inflammation can then spread to the inner lining of the joints (synovium).
• Too much inflammation in the synovium can make the joint lining thick.
• The thick synovium can irritate the joint, causing pain and damage to the cartilage and bones.
• The damage to your joints may later affect nearby muscles, ligaments, and tendons. 

Risk Factors

Some people may be more likely to develop RA than others. Risk factors include:

• Age: Some children may develop juvenile RA. Your risk of chronic seropositive or seronegative RA increases as you age. 
• Genetics: You are more likely to develop RA if you have family members who also have the condition.
• Environmental toxins: Mines, quarries, and steel mills can expose you to silica. This environmental toxin can increase your risk of RA.
• Illness or infection: Some infections, like human immunodeficiency virus (HIV) and hepatitis, have been linked to RA.
• Sex: Women are more likely to develop RA than men. Some evidence suggests that the hormone estrogen may trigger RA.
• Smoking: Long-term tobacco use boosts your risk of RA.
• Stress: Emotional or physical stress may lead to a fast onset of RA if you have a family history of the disease.
• Weight: Obesity may increase your risk.

How Is Rheumatoid Arthritis Diagnosed?

RA can be difficult to diagnose. It can take a long time for the condition to become apparent. Symptoms also tend to vary from person to person. RA symptoms can mimic other joint disorders and make it hard to tell what type of arthritis you have.

No single test can confirm a diagnosis of RA. Diagnosis usually begins with a physical exam and medical history. A healthcare provider may order blood tests that look for inflammation and antibodies.

A healthcare provider might ask you to take an imaging test like an X-ray. Imaging tests don't always detect early changes to your joints and bones. These tests can provide a baseline for keeping track of how RA progresses.

Physical Exam

A healthcare provider can assess your joints with a physical exam. They may ask you to walk around or bend your joints to examine their strength.

A healthcare provider may look for other signs and symptoms of the disease, such as a rash. They might listen to your chest using a stethoscope to hear any signs of inflammation in your lungs.

Medical History

Your medical history can help determine your risk of RA. A healthcare provider may ask about your family history, general health, and lifestyle. They may ask about the severity of your symptoms and how long you have been having joint pain or swelling.

Blood Tests

A healthcare provider can order a blood test to check the counts of different types of antibodies and proteins. Specific blood tests may examine:

• Anti-CCP: These antibodies indicate whether you have seropositive or seronegative RA. Anti-CCP may appear in your blood before you notice symptoms in some cases. A healthcare provider may diagnose and treat RA early if a blood test detects anti-CCP.
• C-reactive protein: This test can detect inflammation. 
• Erythrocyte sedimentation rate (sed rate): This test also measures inflammation in your body.
• Rheumatoid factor (RF): This is another type of antibody that may present in people with RA. 
  

Imaging Tests

X-rays, magnetic resonance imaging (MRI), and ultrasounds can help diagnose RA. It may be hard for these tests to detect any changes or joint damage if your RA is in the early stages. Physical exams, medical history, and blood tests are typically the most reliable diagnostic tools.

Treatments for Rheumatoid Arthritis

A healthcare team will likely include a rheumatologist who specializes in joints, muscles, and bones. The team will work with you to find the best treatment plan for you.

Treatments can help slow the progression of RA and prevent serious joint damage. These typically include a combination of medication, self-care strategies, and therapy. The sooner you begin treatments for RA, the better, as with many other chronic diseases.

Medication

RA is progressive, but you can manage it with medications. A healthcare provider may prescribe medications like:

• Biologics, such as Enbrel (etanercept) and Remicade (infliximab)
• Corticosteroids like prednisone
• COX-2 inhibitors like Celebrex (celecoxib)
• Disease-modifying antirheumatic drugs (DMARDs), which include methotrexate and hydroxychloroquine
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or aspirin
  

Self-Care Strategies

A healthcare team may advise lifestyle changes to protect your joints and alleviate pain. These strategies can include:

• Hot and cold compresses: Alternative hot and cold treatments, such as heating pads and ice, can reduce joint pain and swelling. To lower the risk of burns or frostbite, be sure to use each treatment for no more than 15 minutes at a time.
• Physical activity: Regular exercise strengthens your joints and prevents further damage. Aim for 30 minutes of exercise per day.
• Physical and occupational therapy: A physical therapist can help you learn exercises and massage techniques that ease symptoms and make your joints more mobile. An occupational therapist can teach you how to do daily activities, such as getting dressed or cooking. They can help you pick out assistive devices like a walking cane.
• Physical stress reduction: Avoid work or activities that worsen pressure on your joints. You may find it helpful to ask loved ones to help with tasks, such as carrying groceries or lifting heavy objects.
• Regular check-ups: Communicate with a healthcare team to update them on your symptoms and progress. These check-ins can help them make any changes to your treatment if necessary.
• Weight management: Obesity increases your risk of RA and can worsen symptoms. Maintaining a weight that is right for you can reduce pressure and pain in your joints.

The team may recommend surgery if medication and self-care strategies aren't improving your condition. Surgery is generally a last resort option. A healthcare provider will first try new medications or suggest seeing other specialists (e.g., a physical therapist) before surgery.

How To Prevent Rheumatoid Arthritis Flares

Some people with RA experience flares after periods of remission. These flares can sometimes be unpredictable.

There are a few ways to prevent flares from occurring, such as:

• Getting plenty of sleep
• Limiting alcohol and tobacco use
• Not overexerting yourself
• Reducing emotional stress
• Taking medication on time
  

Living With Rheumatoid Arthritis

The painful symptoms of RA can make it hard to complete daily activities. You can help minimize pain by:

• Applying topical creams or gels for pain relief
• Doing gentle movements and low-impact exercises, such as walking or yoga
• Getting a good night's sleep
• Getting social and emotional support from your loved ones
• Maintaining a healthy weight
• Taking breaks throughout the day
• Trying meditation, deep breathing, and massages
• Using assistive devices, such as canes or walkers, to decrease stress on your joints
• Using cold (e.g., ice packs) to ease pain and swelling or heat (e.g., hot showers or baths) to relax muscles

You might also try an omega-3 fatty acid supplement. Remember, the Food and Drug Administration (FDA) minimally regulates supplements. The effects of omega-3 supplements vary and depend on many variables. Talk to a healthcare provider or pharmacist before starting any supplements.

Living with RA is not only painful but can make you feel frustrated and isolated. Talk to a healthcare provider about other recommendations if these self-care strategies don't seem to be working. You may also find it helpful to ask for a referral to a mental healthcare provider for additional support.

A Quick Review

RA is an autoimmune disease that occurs when your immune system attacks healthy tissue in your joints and causes inflammation and pain. Researchers do not know exactly why RA occurs. Genetic, environmental, and lifestyle factors may increase your risk. 

Consult a healthcare provider if you have RA symptoms or may be at risk for the condition. Early diagnosis and treatment of RA help prevent severe pain and improve your quality of life.

FAQs