Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic (lasting) inflammatory disorder. It causes swelling and pain in the lining of your joints. It can affect other parts of your body, such as the lining of your heart and lungs.

Symptoms of rheumatoid arthritis

Rheumatoid arthritis often occurs in your hands, wrists, feet, and knees first. It can affect several joints at the same time, on both sides of your body. For example, both of your wrists may be painful and stiff. The joints of the fingers and toes can be some of the first places that have pain and stiffness. Over time, RA may affect other joints, such as your jaw, shoulders, and hips.

Symptoms of RA may include one or more of the following:

• Painful and swollen joints, especially in your hands, feet, and knees
• Difficulty moving your joints
• Stiffness and pain in joints, especially after sleeping
• Fever
• Fatigue
• Red, puffy hands
• Hard bumps (called rheumatoid nodules) just under the skin near the joints
• Loss of appetite

What causes rheumatoid arthritis?

Rheumatoid arthritis is a form of arthritis and a type of autoimmune disease. It occurs when the body’s immune system attacks its own joint tissue. The exact cause of this is unknown.

How is rheumatoid arthritis diagnosed?

Your doctor will review your symptoms and do a physical exam. They also may order blood tests, X-rays, or a joint fluid analysis, which tests the fluid in your joints for other possible causes of pain.

Can rheumatoid arthritis be prevented or avoided?

You can’t prevent or avoid rheumatoid arthritis since its cause is unknown. However, you may increase your chances of developing RA if you:

• Are older
• Are a woman
• Are a smoker
• Are overweight
• Have a family history of RA

Rheumatoid arthritis treatment

Treatment of rheumatoid arthritis aims to relieve symptoms, reduce pain, prevent future damage, and improve quality of life. Talk to your doctor about treatment options. They can help you decide which is best for you. Options include medicine, surgery, and lifestyle changes.

Medicine

For mild cases of RA, your doctor may suggest taking over-the-counter (OTC) medicines to reduce inflammation. These include aspirin (one brand name: Bayer), ibuprofen (one brand name: Advil), or naproxen (one brand name: Aleve). Medicines such as acetaminophen (one brand name: Tylenol) can help relieve pain and make you feel better. Your doctor will also prescribe medicines to help treat RA. Prescription pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and swelling. These medicines do have some side effects and should be taken wisely.

Medicines that manage your immune system (called immunosuppressants) also can be used to fight RA. When you have RA, your immune system is out of control. These drugs bring it back to normal. However, they can affect your immune system’s ability to respond to infections.

Your doctor also may prescribe a steroid, such as prednisone. Steroids can reduce pain and swelling, while slowing the damage to your joints. However, they can only be used for a brief time. The longer you use steroids (several months or years), the less effective they become. Steroids do have side effects, such as easy bruising, bone thinning, cataracts, and diabetes.

Anti-rheumatic medicines can help treat RA. If you start taking these drugs early enough, they can slow the damage to your joints. These medicines work slowly, and it may take a few weeks to start feeling better. Your doctor may do a blood test to make sure these medicines are safe for you. Some of these medicines should not be taken if you’re pregnant.

Surgery

For severe cases of RA or cases not effectively treated with medicine, surgery may be an option. Procedures may include correcting a deformity or replacing a joint. Knee and hip replacements are most common. The effects of surgery can help to ease pain and regain joint movement. Talk to your doctor about the benefits and risks of surgery.

Lifestyle changes

There are lifestyle changes you can make to help manage RA.

• Lose weight if you’re overweight.
• Eat a healthy diet.
• Stop smoking.
• Do regular, gentle exercise. This can strengthen the muscles around your joints and lessen fatigue. Mild water aerobics and walking are good exercises to try. If you feel pain in a new joint while exercising, stop and rest. Talk to your doctor if the pain persists.
• Use heat and cold. Heat relaxes tense muscles and cold numbs pain. One way to apply heat is to take a 15-minute hot shower or bath. Cold treatments include ice packs or soaking your joints in cold water. Don’t use these methods if you have poor circulation.
• Reduce the stress on your affected joints. For instance, canes can help you walk. Consider using grabbing tools to help you pick up items. Ask your doctor about other ways to make your daily life easier.

Living with rheumatoid arthritis

Rheumatoid arthritis is a lifelong disease. When it’s treated, it may go away for a little while, but it usually comes back. It’s important to see your doctor as soon as symptoms begin. The earlier you start treatment, the better your outcome. Some of the damage from RA is irreversible, so finding the disease and treating it early is important.

If left untreated, RA can cause other health problems. Your hands may become bent or twisted. Other joints can become deformed. Inflammation will affect your cartilage and bones. Lung and heart problems also can occur. Talk to your doctor if you notice any new symptoms or problems.

Questions for your doctor

• How do I know if my joint pain is caused by rheumatoid arthritis?
• Does RA run in families?
• What medicines would work best for me, and what are the side effects?
• Is there anything I can do to prevent flare-ups of RA?
• What are the pros and cons of surgery to treat RA?
• Does RA affect my life expectancy?

Resources

National Institutes of Health, MedlinePlus: Rheumatoid Arthritis

National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases: Rheumatoid Arthritis