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When you hear the term “arthritis,” you might think of pain and loss of cartilage in joints like knees, ankles, and hands. Rheumatoid arthritis (RA) is an autoimmune disease caused by the immune system attacking the joints rather than by the progressive wear and tear of cartilage over time.
Approximately 1.5 million people in the United States live with RA and 7 out of 10 of them are women. RA can occur at any age, but most commonly begins between the ages of 30 and 50.
Here’s more information about the symptoms, causes, treatments, and other important facts you should know about RA.
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune disease in which the immune system attacks your joints, particularly the synovial membrane, also called the synovial capsule. When the synovial membrane becomes inflamed, it causes pain, swelling, and stiffness.
While RA most commonly affects the joints, it can also damage other parts of the body such as the skin, eyes, blood vessels, heart, and lungs.
What are the symptoms of RA?
RA can start in small joints of the hands and feet, but as the disease progresses, symptoms can also appear in larger joints such as the wrists, elbows, hips, knees, and ankles.
You may notice the following:
- Swollen, hot joints and joint pain
- Joint stiffness in the morning or after rest
- Little appetite
- Feel tired or weak
- Fever
Typically, these symptoms occur in the same joints on both sides of the body. As with other immune diseases, RA symptoms appear suddenly (called a flare) and then relief is felt (called remission).
What is the cause of RA?
Genetics and genetic mutations can account for more than 50% of a person’s risk of developing RA. People with a mutation in the human leukocyte antigen (HLA) gene may be at increased risk of RA.
Certain risk factors can cause you to develop RA, including:
- Smoking tobacco products
- Exposure to occupational hazards such as dust or fibers
- Family history of RA
- Overweight or obesity
- certain infections
What could happen if RA symptoms go untreated?
If RA symptoms are left untreated, this condition could affect other parts of the body and cause problems such as:
- Deformed joints
- Viral infections due to a weakened immune system
- dry eyes
- dry mouth
- In carpal tunnel syndrome, inflammation presses on the nerves in the hands and fingers
- Osteoporosis, caused by weakened bones and increased susceptibility to fractures
- Heart disease
- Lung diseases
- Lymphoma, a cancer of the lymphatic system
Diagnosis of RA
There is no test that can diagnose RA individually. Your doctor may refer you to a rheumatologist, a doctor who specializes in joint and autoimmune diseases. They will perform a physical exam and ask you about your symptoms and medical history.
Blood tests to detect inflammation may include erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Other blood tests detect rheumatoid factor and anticyclic citrullinated peptide antibodies (anti-CCP), which attack the joints.
Imaging procedures such as X-rays, MRI or ultrasound detect inflammation and joint injuries.
Therapeutic options for RA
Treatments for RA have two goals: to relieve pain and inflammation and to prevent or slow the progression of joint damage. Starting treatment early may better protect you from the long-term damage RA can cause.
Doctors often initially prescribe one or more medications. These can include, among others:
- Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, leflunomide and hydroxychloroquine. DMARDs are usually the first therapeutic option to control inflammation and protect joints from deformity.
- Janus kinase (CJ) inhibitors such as tofacitinib and upadacitinib, a newer, targeted type of DMARD that blocks inflammation to reduce joint damage and pain.
- Biopharmaceuticals such as adalimumab and etanercept block inflammatory signals sent to the joints.
- Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term control of inflammation and pain.
Physical therapy exercises or occupational therapy exercises can be helpful to keep your joints moving, relieve fatigue, and reduce pain.
Surgery may also be performed to restore mobility to damaged joints. These may include surgeries to correct a deformity or to replace a hip or knee.
Living with RA
While treatments such as medications and surgery are helpful in managing RA symptoms, there are also things you can do at home.
Low-impact physical activities such as walking or swimming are useful for increasing or maintaining muscle strength around the joints. Repetitive movements such as bending the knees too much can lead to joint injuries. Therefore, avoid these movements as much as possible.
An anti-inflammatory diet (similar to the Mediterranean diet) may be helpful in reducing joint inflammation and the risk of heart disease in people with RA. These include unprocessed foods, fruits, vegetables, omega-3 fatty acids, whole grains and small amounts of sugar.
Maintain a healthy weight, which can reduce inflammation and pain, and if you smoke, try to quit.
Although you may not be able to completely prevent RA, you can take steps to reduce this risk. Prompt treatment could reduce long-term joint damage and help control inflammation and pain.
This educational resource was created with support from Merck.
