What is rheumatoid arthritis?
Rheumatoid arthritis, or RA, is an ongoing, progressive disease that affects the joints of the body with episodes of painful inflammation. RA is an autoimmune disease in which the immune system targets the joint lining (synovium). RA can also cause inflammation and damage to blood vessels and organs.
The onset of rheumatoid arthritis 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 main symptom is painful joint inflammation, but the disease can affect other tissues in the eyes, heart and lungs, too. The hands, wrists and feet are the most commonly affected joints, but RA can involve any joint. RA typically affects both sides of the body at the same time. This is just one of the characteristics that distinguishes RA from osteoarthritis, which is joint wear and tear with age.
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 two years; people with the most severe forms of RA may die even earlier.
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.
What are some conditions related to rheumatoid arthritis?
Rheumatoid arthritis is a type of inflammatory arthritis. Conditions related to RA, or that cause inflammatory arthritis, include:
- Ankylosing spondylitis, inflammation of the spine that can lead to the spinal bones fusing together
- Gout, arthritis caused by the accumulation of uric acid crystals in the joint
- Lupus, an autoimmune disorder causing inflammation throughout the body including the joints
- Polymyalgia rheumatica, inflammation most often affecting the shoulders and hips that is more common in people older than 70
- Psoriatic arthritis, an autoimmune disorder linked to psoriasis, but which can develop in people without skin symptoms
- Scleroderma, an autoimmune disorder that causes inflammation in the skin and other connective tissues
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:
- General stiffness that lasts more than one hour after rising in the morning
- Muscle achiness throughout the body
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 1 to 2 years after the onset of the disease
- Symmetry (both sides equally affected)
Additional symptoms of rheumatoid arthritis include:
- Eye problems (dry eyes, scleritis)
- Nodules under the skin
- Pale skin
- Redness and inflammation of the skin
- Swollen glands
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.
With RA, the antibodies target the joint lining (synovium). This results in inflammation that can eventually destroy joints and damage blood vessels and organs. The most widely held belief is that some environmental factor, such as a viral infection, triggers the abnormal immune response in people with an increased risk of developing RA.
Who gets rheumatoid arthritis?
Anyone can develop rheumatoid arthritis, but the largest at-risk population is women older than 30. Epidemiology studies show:
- In the United States, about 1.3 million adults have rheumatoid arthritis, which is 0.5% of the population.
- RA affects more women than men (estimates range from 1.3 to 3 times higher) and most people are between 30 and 50 years of age at the time of diagnosis.
- Some estimates predict 1 in 12 women and 1 in 20 men will develop RA during their lifetime.
- Juvenile arthritis affects 1 in 1,000 children.
- The disease is present in diverse ethnic groups and populations, but the severity of the disease and its effect on quality of life can differ.
What are the risk factors for rheumatoid arthritis?
Both genetic and environmental factors play a role in RA. Specialists don’t yet know the exact cause, but they do know:
- Variations in certain immune system genes increase the risk of developing RA, but having these variants is not enough to cause the disease.
- Exposure to harmful dust or fibers, and even certain viral and bacterial infections, may trigger the body’s abnormal immune response.
- Long-term smoking is a strong risk factor for RA.
Other RA risk factors include:
- Female biological sex
- Having a family history of rheumatoid arthritis or autoimmune disorders
- Native American ethnicity
You may be able lower your risk of developing rheumatoid arthritis by not smoking.
How do doctors diagnose rheumatoid arthritis?
Doctors diagnose rheumatoid arthritis based on a patient’s symptoms, joint mobility and function, X-rays, and blood test results. A rheumatologist, a doctor who specializes in arthritis, examines the joint for signs of inflammation and damage.
Blood tests are used to detect specific types of antibodies found in some people with RA. Positive blood test results are not enough to confirm an RA diagnosis, but they can help doctors narrow down possible causes of joint pain and other symptoms. One of the antibodies doctors look for are anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies).
Anti-CCP antibodies tend to be present early on in the disease. In fact, some studies show the presence of anti-CCP antibodies in patients many years before they develop symptoms of RA, indicating these antibodies are linked to a greater likelihood of developing the condition.
Rheumatoid factor is another antibody linked to RA, but it is also present in many other autoimmune conditions. Rheumatoid factor is not as specific for RA as anti-CCP antibodies are.
What are the different types of rheumatoid arthritis?
Rheumatoid arthritis is classified as either seropositive or seronegative based on the presence of anti-CCP antibodies in the blood:
- Seropositive RA means there are detectable levels of anti-CCP antibodies in a blood sample. Seropositive RA appears to be linked to more severe disease, but additional studies are necessary to confirm the relationship.
- Seronegative RA means there are no detectable levels of anti-CCP antibodies.
- Juvenile idiopathic arthritis (JIA) is an umbrella term for inflammatory arthritis affecting children 16 and younger. JIA is thought to be an early- onset form of RA when it affects many joints and persists in adulthood. JIA can also be also be seropositive or seronegative.
How is rheumatoid arthritis treated?
The goal of treating RA is to target inflammation to relieve symptoms and put the disease in remission. 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. Rheumatoid arthritis is progressive and chronic, which means treatment usually needs to be continuous, even lifelong in some cases. Doctors often prescribe combinations of drugs for the greatest and most long-lasting effect.
Medications that are commonly used to treat rheumatoid arthritis include:
- Acetaminophen (such as Tylenol), for pain relief
- 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).
- Biologic 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.
Starting treatment early in the disease process improves physical symptoms, delays or prevents joint damage, and reduces the risk of complications. Physical and occupational therapy helps maximize function and prevents or delays disability from RA.
Other treatments for rheumatoid arthritis may include:
- Electrical stimulation
- Fish oil supplements
- Heat 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
- Bleeding gastric ulcers
- Chronic pain
- Immobility and disability
- Instability of neck bones
- Joint deformity and destruction
- 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 or its complications. Early diagnosis and treatment can improve symptoms and reduce your risk of RA complications.
Can you die from rheumatoid arthritis?
Studies have shown that people with RA have a shorter life expectancy than the general population. Findings vary, but life expectancy is about two years shorter for people with RA. The most frequent cause of death related to RA is heart disease. Cardiovascular disease occurs more frequently in people with RA compared to the general population.
Advances in RA diagnosis and treatment can help relieve the physical symptoms and inflammation RA causes, which in turn reduce the risk of complications and improve life expectancy.
How does rheumatoid arthritis affect quality of life?
Living with a chronic disease like rheumatoid arthritis can be overwhelming and result in a low or impaired quality of life. RA symptoms, complications and treatment costs can take a toll physically, emotionally and financially:
- Physical burdens of RA include chronic joint pain, fatigue, and reduced ability to carry out the activities of daily living. Symptoms and complications of RA, such as obesity and premature heart disease, can lead to varying levels of disability.
- Emotional burdens of RA include anxiety and depression. The prevalence of depression is two- to four-times higher in people with RA compared to the general population.
- Financial and occupational burdens include higher healthcare expenses, lost productivity, and inability to work in some cases. Treatment costs can reach $25,000 or more annually depending on the specific medications; most insurance plans offset at least part of these costs.
Rheumatoid arthritis prevalence and awareness
Rheumatoid arthritis and 100 other forms of arthritis are so-called ‘invisible’ illnesses—they are not evident from the “outside”—but they can have long-lasting impacts.
The prevalence of RA appears to be increasing, but simultaneous advances in its treatment have helped reduce its physical burden. People who start treatment early on in the disease and continue with it fare better than people who delay diagnosis or treatment.
May is National Arthritis Month.