Rheumatoid Arthritis

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Introduction

What is rheumatoid arthritis?

Rheumatoid arthritis is an ongoing, progressive disease that affects the joints of the body with episodes of painful inflammation. It is an autoimmune disease that can also cause inflammation and damage to blood vessels and organs.

The onset of rheumatoid arthritis, also known as RA, can occur at any age and affects women more than men. In general, the younger a person is when he or she develops rheumatoid arthritis, the more rapidly the disease progresses.

The severity of rheumatoid arthritis varies greatly among individuals. In some cases, people with the disease become severely disabled. In addition, life expectancy may be shortened by about three to seven years, and those with the most severe forms of RA may die 10 to 15 years earlier than expected.

Complications of rheumatoid arthritis can be serious and include the destruction of joints, disability, and in severe cases, life-threatening complications of organs and blood vessels.

Seek prompt medical care if you have symptoms of rheumatoid arthritis, such as inflammation, pain, stiffness, and swelling of joints. Early diagnosis and treatment can minimize discomfort and reduce your risk of serious complications.

Symptoms

What are the symptoms of rheumatoid arthritis?

Symptoms of rheumatoid arthritis vary greatly from person to person and can be mild, moderate or severe. At the onset of the disease, the symptoms of rheumatoid arthritis are often vague and develop slowly. Symptoms may not include the classic symptom of joint pain that people often associate with rheumatoid arthritis. These indistinct, early symptoms may include:

  • Fatigue
  • General stiffness that lasts more than one hour after rising in the morning
  • Loss of appetite
  • Muscle achiness throughout the body
  • Weakness

Joint symptoms eventually develop and progress. They generally affect the wrists, fingers, knees, feet and ankles on both sides of the body. Joint symptoms include:

  • Hand and feet deformities
  • Inflammation and warmth
  • Joint destruction that develops within one to two years after the onset of the disease
  • Pain
  • Stiffness
  • Swelling
  • Symmetry (both sides equally affected)

Additional symptoms of rheumatoid arthritis include:

  • Eye problems (dry eyes, scleritis)
  • Neuropathy
  • Nodules under the skin
  • Pale skin
  • Pericarditis
  • Redness and inflammation of the skin 
  • Swollen glands
Causes

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is not known, but it is classified as an autoimmune disease. In an autoimmune disease, the body’s immune system mistakes healthy tissues as dangerous to the body and attacks them. This results in inflammation that can eventually destroy joints and damage blood vessels and organs.

What are the risk factors for rheumatoid arthritis?

A number of factors may increase your chances of developing rheumatoid arthritis. Not all people with risk factors will develop rheumatoid arthritis. Risk factors include:

  • Being a woman
  • Having a family history of rheumatoid arthritis or autoimmune disorders
  • Native American ethnicity
  • Smoking

Reducing your risk of rheumatoid arthritis

You may be able lower your risk of developing rheumatoid arthritis by not smoking.

Treatments

How is rheumatoid arthritis treated?

Rheumatoid arthritis treatment plans use a multifaceted approach and are individualized to the stage of advancement of the disease and your age, medical history, and coexisting diseases or conditions. There is no cure for rheumatoid arthritis, but with early recognition and treatment, it is possible to minimize or delay joint damage and complications of the disease, such as chronic pain and disability. Because rheumatoid arthritis is progressive and chronic in nature, treatment usually needs to be continuous, even lifelong in some cases.

Medications that are commonly used to treat rheumatoid arthritis include:

  • Acetaminophen (Tylenol)

  • Corticosteroid medications, which reduce inflammation but have a potential for serious long-term side effects. These drugs are generally used only for short periods and in low doses.

  • Disease-modifying anti-rheumatic drugs (DMARDs), which may reduce inflammation and slow the destruction of joints. Nonbiologic DMARDs are usually started initially. These agents include: methotrexate (MTX), sulfasalazine (SSZ), leflunomide (Arava) and hydroxychloroquine (Plaquenil). Biological DMARDs include the anti-TNF agents: infliximab (Remicade), adalimumab (Humira) and etanercept (Enbrel). Other biologic DMARDs include anakinra (Kineret), abatacept (Orencia), and rituximab (Rituxan)Glucosamine and chondroitin, which can help strengthen damaged joint cartilage.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and aspirin. NSAIDs are effective in treating the pain and inflammation of rheumatoid arthritis. However, long-term use of NSAIDs can cause serious, even adverse events and life-threatening conditions. These include bleeding gastrointestinal ulcers, possible heart problems, and other cardiovascular events.

Other treatments for rheumatoid arthritis may include:

  • Acupuncture

  • Electrical stimulation

  • Fish oil supplementsHeat and cold therapies

  • Occupational therapy to help maximize function

  • Orthopedic splints

  • Physical therapy, including range-of-motion exercises that can help strengthen joints, which supports the muscles and may delay the loss of joint function

  • Surgery to help improve joint pain, correct deformities, and increase function in seriously affected joints. Surgery may include a synovectomy, the removal of the joint lining. Total joint replacement may also be performed in severe cases. In these cases, a diseased joint in the knee or hip is replaced with a new, synthetic joint (prosthesis).

What are the possible complications of rheumatoid arthritis?

Because of the generalized inflammatory nature of rheumatoid arthritis, it can affect almost any organ in the body and lead to serious and life-threatening complications. These include:

  • Adverse effects of treatment

  • Anemia

  • Bleeding gastric ulcers

  • Chronic pain

  • Immobility and disability

  • Instability of neck bones

  • Joint deformity and destruction

  • Nerve problems that cause pain, numbness or tingling

  • Rheumatoid vasculitis, a type of inflammation of the blood vessels, which can lead to atherosclerosis, stroke, heart attack, and other cardiac conditions

  • Skin ulcerations and infections

It is important to seek medical care if you have symptoms of rheumatoid arthritis. Early diagnosis and treatment can minimize discomfort and reduce your risk of these serious complications.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 15
    1. What is Rheumatoid Arthritis? Arthritis Foundation. https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php
    2. Rheumatoid Arthritis (RA). Centers for Disease Control and Prevention. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
    3. Rheumatoid Arthritis. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis

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