Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a disease that causes pain, stiffness, swelling, and loss of movement in your joints. It happens most often in the wrists, knuckles, knees, and feet. It can also affect other parts of the body.

RA usually appears first in early adulthood or middle age. You may have just 1 attack, but more often the symptoms come and go. Repeated attacks can lead to permanent joint damage. The disease cannot be cured. However, you can relieve symptoms and prevent or slow down joint damage by following your healthcare provider’s treatment plan and taking good care of yourself.

What is the cause?

The exact cause of RA is not known. Most experts think that RA is an autoimmune disease. This means that the body's defenses against infection attack the body's own tissue. When you have rheumatoid arthritis, the attack is mostly against the tissues that line the edges of joints. These linings are called synovia. These lining tissues get inflamed, causing pain, swelling, and stiffness. The inflammation also damages joint cartilage and bone, causing misshapen joints.

Things that may cause or contribute to rheumatoid arthritis are:

• genes (passed from parent to child)
• infections
• hormones
• smoking
• long-term exposure to silica or asbestos

Rheumatoid arthritis is the most common form of inflammatory arthritis. The other main type of arthritis is osteoarthritis. Unlike rheumatoid arthritis, osteoarthritis results from wear and tear of the joints.

What are the symptoms?

The symptoms may include:

• joint pain and stiffness, especially in the morning
• red, warm, or swollen joints
• misshapen joints
• mild fever
• tiredness
• loss of appetite
• small lumps or nodules under the skin

How is it diagnosed?

Your healthcare provider will ask about your symptoms, review your medical history, and examine you. Your provider will look for a pattern in the joints that bother you. This can often help your provider know what type of arthritis you have. Rheumatoid arthritis tends to affect many joints, especially the smaller joints of the hands and wrists.

Tests may include:

• blood tests
• joint aspiration, which is a test of fluid from a joint
• X-rays
• MRI scan

The most precise blood tests are the rheumatoid factor test and a test for substances called CCP antibodies.

X-rays of commonly affected joints help your provider see how much the disease has damaged your joints. X-rays of hands and wrists are done most often. You may have X-rays of other joints if they are affected.

How is it treated?

The goals of treatment are to:

• relieve pain and stiffness
• reduce swelling
• keep the shape of the joints more normal so they move well and you do your usual activities
• stop or slow down damage to the joints

There are many ways to treat rheumatoid arthritis. Treatment depends on:

• how severe your symptoms are
• if your symptoms are getting worse
• the effect of the disease on your daily activities

Many drugs are used to treat the symptoms of rheumatoid arthritis. For example:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, can help relieve pain and swelling. They may be bought with or without a prescription. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason. Talk with your healthcare provider to learn more about taking NSAIDs.
• Steroid medicines, such as prednisone or cortisone, are very effective. However, using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
• Disease-modifying antirheumatic drugs (DMARDs) slow down or stop damage to the joints. They can help lessen pain and inflammation in the joints. A commonly used DMARD is methotrexate. Biologic drugs, given as a shot or IV treatment at a clinic, are another type of DMARD. Treatment with DMARDs has to be watched carefully by your provider to avoid serious side effects.

If you have arthritis in your knee, hyaluronic acid can be injected into the knee to act as a lubricant. It helps the knee to move without pain.

Very severe RA may be treated with a medicine that helps your body get rid of cells that make antibodies. For a few people with very severe RA, filtering harmful antibodies out of the blood may be helpful.

Physical therapy helps you to have better use of your joints and muscles. Occupational therapy teaches you how to overcome disability and manage everyday tasks.

You may wear splints to rest inflamed joints and to keep them from getting misshapen.

Sometimes severely damaged hips, knees, wrists, or finger joints may be surgically replaced.

Talk to your healthcare provider about the ways your arthritis can be treated. Your provider may refer you to a rheumatologist—that is, a doctor who specializes in treating inflammatory diseases such as rheumatoid arthritis.

How can I take care of myself?

You can relieve symptoms and help prevent permanently misshapen joints by following these guidelines:

• Take the medicine your healthcare provider recommends.
• Rest your joints when they are warm, swollen, or painful.
• Be as physically active as you can. If you are not exercising, starting an exercise program will improve your sense of well-being. It can also help delay or lessen joint damage. Start your exercise program with the advice and coaching of an expert (your healthcare provider or physical therapist).
• Learn how to move in ways that are easier on your joints. Ask an occupational therapist about new ways to do everyday tasks. Be open to using tools or other equipment so you can put less stress on your joints.
• Join a support group or take classes about managing arthritis symptoms and your health. Encourage your family to also learn about arthritis. Studies have shown that training like this can help you have less pain and feel better.
• If you are overweight, losing some weight can reduce the stress on your joints. Exercise and a healthy diet can help you control your weight and stay healthy.
• Work out a plan ahead of time with your provider for what you should do if you have new symptoms or your symptoms get worse, or if you are having side effects from your medicine.
• Follow any other recommendations from your healthcare provider.

The ability to get pregnant and have children is not affected much by RA. However, some RA medicines can hurt an unborn baby. If you are of child bearing age and are thinking of getting pregnant or could get pregnant, talk to your healthcare provider about it. You may need to stop some RA medicines if you want to get pregnant. Tell your provider right away if you get pregnant while on RA medicines.

How can I help prevent rheumatoid arthritis?

If you are a smoker, you can reduce the risk of RA by quitting.