Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints. Within the body, joints are the points where bones come together and allow for movement. Most of these joints — those called synovial joints — also provide shock absorption.
RA is an?autoimmune condition, in which your immune system mistakes the linings of your joints as "foreign" and attacks and damages them, resulting in inflammation and pain.
This disease most often affects the joints of the hands, wrists, and knees symmetrically. There is no cure, but RA can be managed with good treatment.
Common Questions & Answers
Signs and Symptoms of Rheumatoid Arthritis
Rheumatoid arthritis is a complex disease that is not well understood by medical practitioners or researchers. Early signs of disease, such as joint swelling, joint pain, and joint stiffness, typically begin in a gradual and subtle way, with symptoms slowly developing over a period of weeks to months and getting worse over time. RA usually begins in the small bones of the hands and wrists.
RA is a progressive disease. When left untreated, inflammation can start to develop in other parts of the body, causing various potentially serious complications that can affect other organs, such as the heart, lungs, and nerves, and could cause significant long-term disability. (1)
If you're experiencing RA symptoms, it's crucial to get diagnosed as soon as possible so that you can receive prompt treatment.
Causes and Risk Factors of Rheumatoid Arthritis
RA develops when white blood cells, which normally protect the body from foreign invaders such as bacteria and viruses, enter the synovium (the thin tissue that lines the synovial joints). Inflammation ensues — the synovium thickens, causing swelling, redness, warmth, and pain in the synovial joint.
Over time, the inflamed synovium can damage the cartilage and bone within the joint, as well as weaken supportive muscles, ligaments, and tendons. (2)
Researchers don't know exactly what causes the immune system to invade the synovium, though it's believed that genes and environmental factors play a role in the development of RA.
Research suggests that people with certain genetics, namely the human leukocyte antigen (HLA) genes, have a significantly increased risk of developing RA. (3) The HLA gene complex controls immune responses by producing proteins that help the immune system recognize proteins from foreign invaders.
Other genes connected to RA include some involved with the immune system and inflammation, such as STAT4, TRAF1, C5, and PTPN22. (3)
But not everyone with these identified gene variants develops RA, and people without them can still develop it. So it's likely that environmental factors often trigger the disease, particularly in people with a genetic makeup that makes them more susceptible to it. These factors include:
- Viruses and bacteria (though certain infections may?reduce RA risk, at least temporarily)
- Exposure to certain kinds of dust and fibers
- Exposure to secondhand?smoke (4)
- Obesity (obesity also increases progression of disability for people with RA) (5)
- Severely stressful events
Equally important are smoking and a family history of RA in increasing a person's risk of developing the condition. (6)
How Is Rheumatoid Arthritis Diagnosed?
While no single test can definitively diagnose RA, doctors consider several factors when evaluating a person for rheumatoid arthritis.
The diagnostic process typically begins when a doctor gets your medical history and conducts a physical exam. You doctor will ask you about your symptoms to look for signs of RA, in particular things like prolonged joint swelling and morning stiffness that lasts at least half an hour after you wake up.
Next, your doctor will order blood tests to detect rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), which can be specific markers for RA and could indicate RA. There is also something called seronegative RA, which is RF negative. One can still have symmetrical inflammatory arthritis with or without systemic markers of inflammation.
Imaging tests such as?X-ray,?ultrasound,?and?magnetic resonance imagery?scans may be used to help a doctor determine if your joints have been damaged or to detect joint inflammation, erosion, and fluid buildup.
Risk factors for rheumatoid arthritis include a personal history of smoking and a family history of RA. (1,7)
The Different Types of Rheumatoid Arthritis
Rheumatoid arthritis is classified as either seropositive or seronegative.
People with seronegative RA have the disease without the presence of the antibodies or RF in their blood.
Duration of Rheumatoid Arthritis
RA is a progressive and chronic disease. Damage to the joint bones occurs very early in the progression of the disease, typically within the first two years. (10) That's why early treatment is so important.
With effective, early treatment, most people with RA can live as they normally would, and many people can achieve remission of symptoms. This doesn't mean that you're cured but rather that your symptoms are alleviated to the point that you can function at your fullest and your joints are not being further damaged by RA.
But remission doesn't happen for everyone, and because the pain and other symptoms of RA may change over time, pain management can be an ongoing concern. In addition to pain medications like nonsteroidal anti-inflammatory drugs and corticosteroids, there are many options for pain relief for people living with RA. These include, among others:
- Fish oil supplements
- Hot and cold treatments
- Exercise and movement
- Mind-body modalities such as mindfulness-based stress reduction?and?acceptance and commitment therapy
Treatment and Medication Options for Rheumatoid Arthritis
To treat RA, doctors aim to stop the progression of the disease by reducing symptoms, controlling inflammation, minimizing joint and organ damage, and improving physical function.
Proven treatments include medication and physical therapy. Early, aggressive measures can help control symptoms and complications before the disease significantly worsens, by reducing or altogether stopping inflammation as quickly as possible.
This strategy is essential to preventing disability, and it usually amounts to treatment with anti-inflammatory drugs, and sometimes more than one medication at a time. (11)
In recent years, there have been significant advancements in medicines for treating RA, but there is still no cure. Medications known as disease-modifying anti-rheumatic drugs (DMARDs)?are considered the gold standard for RA treatment.
DMARDs can change or slow the progression of the disease, helping prevent severe joint damage and other complications.
In general, the drugs work by slowing the inflammation and protecting the joints from further damage, and are generally prescribed shortly after diagnosis. The type of DMARD a doctor prescribes depends on several factors, including disease severity and the balance between the medication's benefits and potential side effects.
Nonsteroidal anti-inflammatory drugs (NSAIDS) and corticosteroids are used to treat pain and inflammation.
Alternative and Complementary Therapies for Rheumatoid Arthritis
Certain?lifestyle changes and home remedies?may be beneficial, in addition to the conventional treatment of medication, physical therapy, and surgery, if needed.
Some people have found relief from RA symptoms through acupuncture, tai chi, and?yoga, though the scientific evidence supporting this isn't particularly conclusive. Complementary or alternative therapies, such as homeopathy, hydrotherapy, or cryotherapy, might also be worth considering to help relieve RA pain and stiffness.
You should always check with your medical provider before trying any complementary or alternative therapies.
Many people can manage RA with medication and physical therapy, but joint surgery?may be an option if your joint damage is severe and limiting your quality of life.
Complications of Rheumatoid Arthritis
It's well established that rheumatic diseases such as RA increase the risks for developing a variety of health conditions.
The most common RA comorbidity is cardiovascular disease, but the condition is also associated with several specific cardiovascular issues, including?heart attack,?stroke,?congestive heart failure, peripheral vascular disease, and atherosclerosis.
It's important for people with RA to work with their doctors to assess their heart disease risk factors, such as high blood pressure, diabetes, and smoking, and reduce them.
RA can also lead to inflammation in other areas of the body, including blood vessels, where it's known as rheumatoid?vasculitis; the lungs, resulting in rheumatoid?lung disease or other conditions; the eyes; and the wrists, causing?carpal tunnel syndrome.
Another possible complication is kidney impairment as a result of RA medication. And pregnant women need to be aware that RA is linked to pregnancy complications, such as hypertension (high blood pressure) during late pregnancy, and increased risk of premature delivery. (1)
Dietary Modifications to Consider for Rheumatoid Arthritis
While there is a lot of interest in the role of diet and nutrition in symptom management for rheumatoid arthritis, there is no comprehensive research on the topic nor is there a dietary magic formula to fight RA symptoms.
But some evidence suggests that eating certain foods may help reduce inflammation and improve symptoms for some people, while others have been shown to worsen inflammation and related symptoms.
For instance, the ketogenic diet — which is high in fats that promote inflammation and low in certain healthy grains, fruits, and vegetables that help fight inflammation — is generally believed to be bad for RA symptoms and pain.
On the other hand, the Mediterranean diet is high in seafood (omega-3 fatty acids) and fiber, which can help fight inflammation. It's sometimes called the anti-inflammatory diet or arthritis diet. (12)
Research and Statistics: Who Has Rheumatoid Arthritis?
About 1 percent of Americans live with rheumatoid arthritis. According to a 2017 report in the journal?Rheumatoid International, the prevalence of RA in the United States increased between 2004 and 2014,?affecting about 1.3 million adults in 2014.?(13)
Women are more likely than men to develop at an early age, and 2 to 3 times as many women as men develop RA, according to the Centers for Disease Control and Prevention (CDC). (14) About 70 percent of people with RA are women. (3)
Inflammatory arthritis can affect children. It's known as?juvenile idiopathic arthritis (JIA), and it affects between 1 in 1,000 and 1 in 2,500 children (30,000 to 75,000 children) in the United States, according to?2015 census data estimates. (15) JIA?can't be diagnosed with a blood test, so doctors consider symptoms and medical history to rule out conditions that can resemble JIA, such as infections, cancer, Lyme disease, bone disorders, and lupus.
Conditions Related to Rheumatoid Arthritis
There are several kinds of arthritis ("arth" is Latin for "joint" and "itis" is Latin for "disease" or "inflammation"), including RA, osteoarthritis, gout, and lupus. (16)?Osteoarthritis?is the most common type of arthritis, affecting more than 30 million Americans, according to the CDC. (17,18)
Rheumatoid arthritis and osteoarthritis affect the body differently. In RA, the joint lining becomes inflamed and eventually erodes the joint. But in osteoarthritis, the cartilage that covers the ends of the bones in a joint is damaged by multiple different causes, and it is considered more of a mechanical (wear and tear) disease. (18)
There are other health conditions related to rheumatoid arthritis, too. Osteoporosis, or low bone density, as well as mental health conditions like?anxiety?and depression are also common in people with RA. (19,20) Pulmonary conditions are linked to RA as well. About 20 to 30 percent of people with RA will eventually develop an RA-related lung disease, such as?asthma,?chronic obstructive pulmonary disease, or interstitial lung disease, according to the Arthritis Foundation.?(21)
Resources We Love
Favorite Orgs for Essential Rheumatoid Arthritis Information
The?American College of Rheumatology is an organization for physicians, health professionals, and scientists that advances?rheumatology?through education, research, advocacy, and practice support relating to the care of people with?arthritis?and?rheumatic?and?musculoskeletal diseases. It publishes two?medical journals?(Arthritis & Rheumatology?and?Arthritis Care & Research) and promotes (through the Research and Education Foundation) research into rheumatological conditions, including the formulation of diagnostic criteria for diseases.
The?Arthritis Foundation?is a nonprofit organization dedicated to the prevention, control, and cure of arthritis. The foundation provides information and resources, access to optimal care, advancements in science, and community networking. It also publishes?Arthritis Today,?a magazine that reaches 4.2 million readers.
CreakyJoints?is a leading support, education, advocacy, and research organization for people living with arthritis and rheumatic disease. It is dedicated to raising awareness of all forms of arthritis, which includes educating people about the available varieties of treatment and management strategies.
Favorite Online Support Network for RA
The Live Yes! Arthritis Network provides a network of support with the aim of helping people live their best lives. By exchanging ideas, tips, and experiences?with others in provided online forums covering a variety of topics, the network empowers people with rheumatoid arthritis to gain confidence in dealing with their disease proactively.
Favorite Apps, Products, and Gadgets
CreakyJoints has partnered with rheumatology researchers at the University of Alabama at Birmingham to create this useful app that helps you track your symptoms and medications and share your experiences of living with RA. In addition to RA, the app also includes research for conditions such as ankylosing spondylitis; psoriatic arthritis; psoriasis; osteoporosis, osteopenia, and low bone mineral density; osteoarthritis; fibromyalgia; gout; juvenile idiopathic arthritis; inflammatory bowel diseases, like Crohn’s and ulcerative colitis; lupus; scleroderma (systemic sclerosis); polymyositis; and dermatomyositis.
Dycem's self-adhering Super Grip Tape provides a cushioned grip that feels more comfortable on the hands. The tape adheres to a variety of surfaces, including brooms, wheelchair arms, mobility devices, and even pens and cutlery. The nonslip grip will help increase the friction of any surface you grab.
The Open Ease Automatic Jar Opener can handle any jar with lids that are 1 to 4 inches in diameter. Press a single button to engage the jar and open the lid, saving your joints the strain of twisting stubborn lids.?
IMAK?Compression Arthritis Gloves, $23
Many people with rheumatoid arthritis consider compression gloves a must-have accessory. According to a?study?published in November 2014 in Therapeutic Advances in Musculoskeletal Disease, hand symptoms including pain, stiffness, and swelling improve greatly with the use of compression gloves.?IMAK?remains one of the easiest brands of gloves to find, both?online?and in?stores.
Sunbeam's electric blanket can help those with arthritis get off to a better start in the morning by providing the heat necessary to help loosen stiff joints. An easy-to-use controller can adjust the blanket through 10 heating levels to help you warm up your joints before getting out of bed. The blanket comes in twin, full, queen, and king sizes to fit all standard-sized beds.
Favorite Patient Blogs
Over a period of two and a half years, Eileen Davidson was diagnosed with rheumatoid arthritis, osteoarthritis, and fibromyalgia. She began writing?Chronic Eileen?in June 2017 as a way to battle her struggles with progressing anxiety and depression and to help her handle her new role as a mother with a chronic illness (her article on?parenting techniques?is definitely worth the read). Her posts share many of these ideas, such as?whether arthritis will make tattoos hurt?or?how to calm the “bitch within” when living with a chronic illness.
With 25 years of corporate communications experience, Carla Kienast has focused her messaging skill on helping others living with rheumatoid arthritis through her blog. Diagnosed with RA in 2008, Kienast has been through 19 surgeries, including three joint replacements, two spinal fusions, and two rotator cuff operations. She describes her extraordinary experiences dealing with hip and shoulder surgeries, and covers her various, and sometimes ineffective, drug treatments, all with a sense of humor.
Mariah was diagnosed with rheumatoid arthritis at age 25 while pursuing dual graduate degrees. Since then, she has undoubtedly made the most of living with a chronic illness, including giving birth to her third child. In addition to her blog, Mariah writes for various health websites, including Mamas Facing Forward, and pays special attention to mothers living with RA in her articles on?sex,?parenting,?treatment, and?ordinary life with RA.
RELATED:?10 Arthritis Blogs to Watch in 2020
Favorite Annual Meetings
Every year, nearly 16,000 rheumatologists, rheumatology health professionals, fellows in training, patient advocates, and exhibitors from over 100 countries gather to discuss the latest scientific advances and clinical issues surrounding rheumatoid arthritis. The annual convention hosts over 450 sessions that provide ample opportunity for professional development, networking, and access to the latest rheumatology research and clinical applications.
Rheumatoid Arthritis and COVID-19
As the novel coronavirus persists, you know you must take extra precautions to protect your health. Find the latest, most accurate information in our guide.
Editorial Sources and Fact-Checking
- Patient Education: Rheumatoid Arthritis Symptoms?and Diagnosis (Beyond the Basics).?UpToDate. December 2019.
- Rheumatoid Arthritis: When Your Immune System Attacks Your Body. NIH MedlinePlus.?Summer 2014.
- Rheumatoid Arthritis. U.S. National Library of Medicine Genetics Home Reference.
- Seror?R, Henry J, Gusto G, et al. Passive Smoking in Childhood Increases the Risk of Developing Rheumatoid Arthritis. Rheumatology. July 2019.
- Baker JF, England BR, Mikuls?TR, et al. Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis.?Arthritis Care & Research. April 2018.
- Rheumatoid Arthritis Causes. NHS. August 28, 2019.
- Rheumatoid Arthritis. Arthritis Foundation.
- What “Type” of RA Do You Have??Arthritis Foundation.
- RA Types: What Distinguishes Types of Rheumatoid Arthritis??Rheumatoid Arthritis Support Network. October 27, 2018.
- Rheumatoid Arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 2019.
- DMARDs. Arthritis Foundation.
- Hagen KB,?Byfuglien?MG,?Falzon?L, et al. Dietary Interventions for Rheumatoid Arthritis.?The?Cochrane?Database of Systematic Reviews. January 2009.
- Hunter TM, Boytsov?NN, Zhang X, et al. Prevalence of Rheumatoid Arthritis in the United States Adult Population in Healthcare?Claims Databases, 2004–2014,?Rheumatology International.?September 2017.
- Rheumatoid Arthritis. Centers for Disease Control and Prevention. March 2019.
- Juvenile Arthritis.?American College of Rheumatology.?March 2019.
- What Is Arthritis??Arthritis Foundation.
- Arthritis-Related Statistics. Centers for Disease Control and Prevention.?July 18, 2018.
- Osteoarthritis (OA). Centers for Disease Control and Prevention. January 10, 2019.
- What People With Rheumatoid Arthritis Need to Know About Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases.?November 2018.
- Arthritis and Mental Health. Arthritis Foundation.
- Rheumatoid Arthritis and Lung Problems. Arthritis Foundation.