Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints.
RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include:
- Genes—people with rheumatoid arthritis may have a specific genetic defect that increases their risk for developing this condition
- Defects in the immune system may cause the immune cells to fail to recognize the body’s own tissues
- Infection with specific viruses or bacteria that kick off an abnormal immune response
- Chemical or hormonal imbalances in the body
RA is more common in women, and in people between the ages of 30 and 60. Other factors that may increase your chance of developing RA include:
RA usually presents with joint symptoms
- Symptoms involve 2 or more joints which are usually:
- Smaller joints
- The same joints on both sides of the body
- Symptoms include:
- Increased pain and stiffness in the morning and after inactivity that lasts more than 30 minutes
- Red, swollen, warm joints
- Deformed, misshapen joints
RA may also cause:
- Intense fatigue, decreased energy
- Muscle aches
- Decreased appetite
- Weight loss
- Fever and sweats
- Small lumps or nodules under the skin
Inflammation may also occur in
- Blood and blood vessels
You will be asked about your symptoms and medical history. A physical exam will be done. RA is sometimes difficult to diagnose because there are several diseases with similar symptoms. Part of diagnosing RA is to rule out other diseases.
The American College of Rheumatology and the European League Against Rheumatism have created a system for diagnosing RA. To start, symptoms need to be present for 6 weeks or more. The system then uses a 10-point scale assessing specific symptoms. The higher the score, the more likely RA is present. Considered factors include:
- The number of swollen or sore joints with any associated damage. This includes both small and large joints. Which joints are affected, how many joints are affected, and for how long they have been affected all help with the diagnosis.
- Blood tests that look for markers of RA. Specific substances, such as those associated with autoimmunity and inflammation, may be present in the blood.
- Imaging tests to look at the affected joint and surrounding structures. These may include:
- Tissue samples include:
- Synovial biopsy—Removing a piece of the synovial membrane that lines the joint capsule.
- Arthrocentesis (joint aspiration)—Removal of synovial fluid from the joint with a needle.
There is no cure for RA. The goals of treatment are to:
- Relieve pain
- Reduce inflammation
- Slow down joint damage
- Improve functional ability
There are a variety of medications to treat the pain and inflammation of RA. In some cases, medications may be used in combination. These may include:
- Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, cyclooxgenase-2, or COX-2 inhibitors. They may be applied to the skin or taken by mouth.
- Disease-modifying antirheumatic drugs (DMARDs) are injected under the skin or taken by mouth. DMARDs include:
- Nonbiologics suppress the immune system. The most common is nonbiologic DMARD is methotrexate.
- Biologics attempt to repair, stimulate, or enhance the immune system. Common biologic DMARDs include adalimumab, etanercept, and abatacept.
- Corticosteroids—injected into the joint (less common)
Rest and Exercise
Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.
These steps may help relieve stiffness, weakness, and reduce inflammation:
- Maintain a balance between rest and exercise
- Attempt mild strength training
- Participate in aerobic exercise, such as, walking, swimming, or dancing
- Avoid heavy-impact exercise
- Control weight
- Participate in a physical therapy program
Splints applied to painful joints may reduce pain. Devices that help with daily activities can also reduce stress on joints. Devices include:
- Zipper extenders
- Long-handled shoehorns
- Specially designed kitchen tools
Stress reduction can ease the difficulties of living with a chronic, painful disease. Participating in an exercise program or joining a support group are 2 strategies you can use to reduce stress. Cognitive behavioral therapy , a form of talk therapy, and meditation may also offer benefits in reducing your pain and improving your ability to cope with RA.
Joint replacement and tendon reconstruction help relieve severe joint damage.
- Reviewer: Michael Woods, MD
- Review Date: 11/2016 -
- Update Date: 05/13/2016 -