Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs mostly in the:

• Fingers
• Wrists
• Elbows
• Shoulders
• Jaw
• Hips
• Knees
• Toes

RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes:

• Genetic factors—Certain genes that play a role in the immune system are associated with RA development.
• Defects in the immune system can cause ongoing inflammation.
• Environmental factors—Certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA.
• Other factors—Some evidence suggests that hormonal factors may promote RA development in combination with genetic factors and environmental exposure.

These factors increase your chance of developing RA. Tell your doctor if you have any of these risk factors:

• Family members with RA
• Sex: female
• Ethnic background: Pima Indians
• Heavy or long-term smoking

When RA begins, symptoms may include:

• Joint pain and stiffness that is:
  • Symmetrical
  • Most prominent in the morning
  • Lasts for at least half an hour
• Red, warm, or swollen joints
• Joint deformity
• Mild fever, tiredness
• Loss of appetite
• Small lumps or nodules under the skin

As RA progresses, it may cause complications with the:

• Heart
• Lungs
• Eyes
• Skin
• Liver
• Kidneys
• Blood
• Nervous system
• Blood vessels

It is also linked to early cardiovascular disease and death.

There is no single test for RA. The doctor will ask about your symptoms and medical history. She will examine your joints, skin, reflexes, and muscle strength.

Tests:

• Rheumatoid factor (RF) level in the blood
• Erythrocyte sedimentation rate (ESR) of the blood—to measure inflammation in the body
• C-reactive protein (CRP) —an indicator of active inflammation in the blood
• White blood cell count
• X-rays of affected joints (especially dual energy x-ray absorptiometry )—a test that uses radiation to take a picture of structures inside the body, especially bones

There is no cure for RA. The goals of treatment are to:

• Relieve pain
• Reduce inflammation
• Slow down joint damage
• Improve functional ability

• Disease-modifying anti-rheumatic drugs (DMARDS)—to slow the course of the disease; used early in the course of the disease to prevent long-term damage:
  • Methotrexate (eg, Rheumatrex)
  • Hydroxychloroquine (eg, Plaquenil)
  • Sulfasalazine (eg, Azulfidine)
  • Leflunomide (eg, Arava)
  • Cyclosporine (eg, Neoral)
  • Penicillamine (eg, Cuprimine)
  • Gold (eg, Ridaura)
  • Minocycline (eg, Minocin)
• Immunosuppressive drugs (only used when other DMARDS are ineffective):
  • Azathioprine (eg, Imuran)
  • Cyclophosphamide (eg, Cytoxan)—rarely used
  • Chlorambucil (eg, Leukeran)—rarely used
• Over-the-counter medicines:
  • Acetaminophen (eg, Tylenol)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen
• Biologic response modifiers—drugs that interfere with the autoimmune response; includes TNF-inhibitors, such as:
  • Etanercept (eg, Enbrel)
  • Infliximab (eg, Remicade)
  • Adalimumab (eg, Humira)
  • Golimumab (eg, Simponi)
  • Certolizumab (eg, Cimzia)

Low-dose corticosteroids (eg, prednisone ) are often used first. They may be tapered when other drugs start working. Avoid long-term steroid use. Corticosteroid injections to inflamed joints may also be used.

Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.

Splints applied to painful joints may reduce pain and swelling. Devices that help with daily activities can also reduce stress on joints. Devices include:

• Zipper extenders
• Long-handled shoehorns
• Specially designed kitchen tools

Stress reduction can ease the difficulties of living with a chronic, painful disease. Participating in an exercise program or joining a support group are two strategies you can use to reduce stress. Cognitive behavioral therapy , a form of talk therapy, and meditation may also offer benefits in reducing your pain and improving your ability to cope with RA.

Joint replacement and tendon reconstruction help relieve severe joint damage.

These may relieve stiffness and weakness and reduce inflammation:

• Maintain a balance between rest and exercise.
• Attempt mild strength training.
• Participate in aerobic exercise (eg, walking, swimming, dancing).
• Avoid heavy impact exercise.
• If you smoke, quit .
• Control weight.
• Participate in a physical therapy program.