RHEUMATOID ARTHRITIS
o Small joints (wrists, certain joints in the hands
Rheumatoid arthritis is an inflammatory type of arthritis
that can causes joint pain, swelling and damage. Learn
what causes RA and how to treat it.
o Rheumatoid arthritis (RA) causes joint
inflammation and pain. It happens when the
immune system doesn’t work properly and
attacks the lining of the joints (called the
synovium).
o The disease commonly affects the hands, knees
or ankles, and usually the same joint on both
sides of the body. But sometimes, RA causes
problems in other parts of the body as well, such
as the eyes, heart and circulatory system and/or
lungs.
o For unknown reasons, more women than men
get RA, and it usually develops in middle age.
Having a family member with RA increases the
odds of developing RA.
CAUSES
In a healthy person, the immune system fights invaders,
such as bacteria and viruses. With an autoimmune
disease like RA, the immune system mistakes the body’s
cells for foreign invaders and releases inflammatory
chemicals that attack, in the case of RA, the synovium.
That’s the tissue lining around a joint that produces a
fluid to help the joint move smoothly. The inflamed
synovium gets thicker and makes the joint area feel
painful and tender, look red and swollen and moving the
joint may be difficult.
Researchers aren’t sure why some people develop RA.
They think that these individuals have certain genes that
are activated by a trigger in the environment, like a virus
or bacteria, or physical or emotional stress or some other
external factor.
SYMPTOMS
In the early stages, people with RA may not see redness
or swelling in the joints, but they may experience
tenderness and pain.
These symptoms are clues to RA:
o Joint pain, tenderness, swelling or stiffness that
lasts for six weeks or longer.
o Morning stiffness that lasts for 30 minutes or
longer.
o More than one joint is affected.
and feet) are typically affected first.
o The same joints on both sides of the body are
affected.
o Many people with RA get very tired (fatigue)
and some may have a low-grade fever.
o RA symptoms may come and go.
o Having a lot of inflammation and other
symptoms is called a flare.
o A flare can last for days or months.
RISK FACTORS
Factors that may increase your risk of rheumatoid
arthritis include:
o SEX. Women are more likely than men to
develop rheumatoid arthritis.
o AGE. Rheumatoid arthritis can occur at any age,
but it most commonly begins in middle age.
o FAMILY HISTORY. If a member of your
family has rheumatoid arthritis, you may have
an increased risk of the disease.
o SMOKING. Cigarette smoking increases your
risk of developing rheumatoid arthritis,
particularly if you have a genetic predisposition
for developing the disease. Smoking also
appears to be associated with greater disease
severity.
o EXCESS WEIGHT. People who are overweight
appear to be at a somewhat higher risk of
developing rheumatoid arthritis.
COMPLICATIONS
Rheumatoid arthritis increases your risk of developing:
o OSTEOPOROSIS. Rheumatoid arthritis itself,
along with some medications used for treating
rheumatoid arthritis, can increase your risk of
osteoporosis — a condition that weakens your
bones and makes them more prone to fracture.
o RHEUMATOID NODULES. These firm bumps
of tissue most commonly form around pressure
points, such as the elbows. However, these
nodules can form anywhere in the body,
including the heart and lungs.
EYES.
o Dryness, pain, inflammation, redness, sensitivity
to light and trouble seeing properly.
MOUTH.
 o Dryness and gum inflammation, irritation or
infection.
SKIN.
o Rheumatoid nodules – small lumps under the
skin over bony areas.
LUNGS.
o Inflammation and scarring that can lead to
shortness of breath and lung disease.
BLOOD VESSELS.
o Inflammation of blood vessels that can lead to
damage in the nerves, skin and other organs.
BLOOD.
o A lower than normal number of red blood cells.
HEART.
o Inflammation can damage the heart muscle and
the surrounding areas.
o Painful joints also make it hard to exercise,
leading to weight gain. Being overweight may
make people with RA more likely to develop
high cholesterol, diabetes, heart disease and high
blood pressure.
DIAGNOSIS
o Getting an accurate diagnosis as soon as possible
is the first step to treating RA effectively.
o A doctor with specialized training in treating
arthritis (called a rheumatologist) is the best
person to make a correct diagnosis, using
medical history, a physical examination and lab
tests.
MEDICAL HISTORY.
o The doctor will ask about joint symptoms (pain,
tenderness, stiffness, difficulty moving), when
they started, if they come and go, how severe
they are, what actions make them better or worse
and whether family members have RA or
another autoimmune disease.
PHYSICAL EXAMINATION.
o The doctor will look for joint tenderness,
swelling, warmth and painful or limited
movement, bumps under the skin or a low-grade
fever.
BLOOD TESTS.
o The blood tests look for inflammation and blood
proteins (antibodies) that are linked to RA:
o Erythrocyte sedimentation rate (ESR, or “sed
rate”) and C-reactive protein (CRP) levels are
markers for inflammation. A high ESR or CRP
combined with other clues to RA helps make the
diagnosis.
o Rheumatoid factor (RF) is an antibody found
(eventually) in about 80 percent of people with
RA. Antibodies to cyclic citrullinated peptide
(CCP) are found in 60 to 70 percent of people
with RA. However, they are also found in people
without RA.
IMAGING TESTS.
o RA can cause the ends of the bones within a
joint to wear down (erosions). An X-ray,
ultrasound, or MRI (magnetic resonance
imaging) scan can look for erosions. But if they
don’t show up on the first tests that could mean
RA is in an early stage and hasn’t damaged bone
yet. Imaging results can also show how well
treatment is working.
TREATMENT
There is no cure for rheumatoid arthritis. But clinical
studies indicate that remission of symptoms is more
likely when treatment begins early with medications
known as disease-modifying antirheumatic drugs
(DMARDs).
MEDICATIONS
The types of medications recommended by your doctor
will depend on the severity of your symptoms and how
long you've had rheumatoid arthritis.
o NSAIDs. Nonsteroidal anti-inflammatory drugs
(NSAIDs) can relieve pain and reduce
inflammation. Over-the-counter NSAIDs
include ibuprofen (Advil, Motrin IB, others) and
naproxen sodium (Aleve). Stronger NSAIDs are
available by prescription. Side effects may
include stomach irritation, heart problems and
kidney damage.
o Steroids. Corticosteroid medications, such as
prednisone, reduce inflammation and pain and
slow joint damage. Side effects may include
 thinning of bones, weight gain and diabetes.
Doctors often prescribe a corticosteroid to
relieve symptoms quickly, with the goal of
gradually tapering off the medication.
o Conventional DMARDs. These drugs can slow
the progression of rheumatoid arthritis and save
the joints and other tissues from permanent
damage. Common DMARDs include
methotrexate (Trexall, Otrexup, others),
leflunomide (Arava), hydroxychloroquine
(Plaquenil) and sulfasalazine (Azulfidine). Side
effects vary but may include liver damage and
severe lung infections.
o Biologic agents. Also known as biologic
response modifiers, this newer class of
DMARDs includes abatacept (Orencia),
adalimumab (Humira), anakinra (Kineret),
certolizumab (Cimzia), etanercept (Enbrel),
golimumab (Simponi), infliximab (Remicade),
rituximab (Rituxan), sarilumab (Kevzara) and
tocilizumab (Actemra).
o Biologic DMARDs are usually most effective
when paired with a conventional DMARD, such
as methotrexate. This type of drug also increases
the risk of infections.
o Targeted synthetic DMARDs. Baricitinib
(Olumiant), tofacitinib (Xeljanz) and
upadacitinib (Rinvoq) may be used if
conventional DMARDs and biologics haven't
been effective. Higher doses of tofacitinib can
increase the risk of blood clots in the lungs,
serious heart-related events and cancer.
THERAPY
o Your doctor may refer you to a physical or
occupational therapist who can teach you
exercises to help keep your joints flexible. The
therapist may also suggest new ways to do daily
tasks that will be easier on your joints. For
example, you may want to pick up an object
using your forearms.
o Assistive devices can make it easier to avoid
stressing your painful joints. For instance, a
kitchen knife equipped with a hand grip helps
protect your finger and wrist joints. Certain
tools, such as buttonhooks, can make it easier to
get dressed. Catalogs and medical supply stores
are good places to look for ideas.
SURGERY
o If medications fail to prevent or slow joint
damage, you and your doctor may consider
surgery to repair damaged joints. Surgery may
help restore your ability to use your joint. It can
also reduce pain and improve function.
Rheumatoid arthritis surgery may involve one or more of
the following procedures:
o SYNOVECTOMY. Surgery to remove the
inflamed lining of the joint (synovium) can help
reduce pain and improve the joint's flexibility.
o TENDON REPAIR. Inflammation and joint
damage may cause tendons around your joint to
loosen or rupture. Your surgeon may be able to
repair the tendons around your joint.
o JOINT FUSION. Surgically fusing a joint may
be recommended to stabilize or realign a joint
and for pain relief when a joint replacement isn't
an option.
o TOTAL JOINT REPLACEMENT. During joint
replacement surgery, your surgeon removes the
damaged parts of your joint and inserts a
prosthesis made of metal and plastic.
FAST FACTS
o Rheumatoid arthritis (RA) is the most common
type of autoimmune arthritis. It is caused when
the immune system (the body’s defense system)
is not working properly. RA causes pain and
swelling in the wrist and small joints of the hand
and feet.
o Treatments for RA can stop joint pain and
swelling. Treatment also prevents joint damage.
Early treatment will give better long term
results.
o Regular low-impact exercises, such as walking,
and exercises can increase muscle strength. This
will improve your overall health and lower
pressure on your joints.
o Studies show that people who receive early
treatment for RA feel better sooner and more
often, and are more likely to lead an active life.
They also are less likely to have the type of joint
damage that leads to joint replacement.
o It is important to get the help of a
rheumatologist. A rheumatologist is a doctor
who treats arthritis and autoimmune disease.
There are diseases that can be mistaken for RA.
It is important to get the correct diagnosis
without unnecessary testing. A rheumatologist
will help find a treatment plan that is best for
your disease.