RA; Arthritis - rheumatoid
Rheumatoid arthritis (RA) is a long-term disease. It leads to inflammation of the joints and surrounding tissues. It can also affect other organs.
The cause of RA is unknown. It is an autoimmune disease. This means the body's immune system mistakenly attacks healthy tissue.
RA can occur at any age, but is more common in middle age. Women get RA more often than men.
Infection, genes, and hormone changes may be linked to the disease. Smoking may also be linked to RA.
It is much less common than osteoarthritis, which is a condition that occurs in many people due to wear and tear on the joints as they age.
Most of the time, RA affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected.
The disease often begins slowly. Early symptoms may include minor joint pain, stiffness, and fatigue.
Joint symptoms may include:
Other symptoms include:
There is no test that can determine for sure whether you have RA. Most people with RA will have some abnormal test results. However, some people will have normal results for all tests.
Two lab tests that often help in the diagnosis are:
Other tests that may be done include:
RA most often requires long-term treatment. Treatment includes medicines, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA with newer drug categories can be very helpful to slow joint destruction and prevent deformities.
Disease modifying antirheumatic drugs (DMARDs): These are often the drugs that are tried first in people with RA. They are prescribed along with rest, strengthening exercise, and anti-inflammatory drugs.
Anti-inflammatory medicines: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib.
Antimalarial medicines: This group of medicines includes hydroxychloroquine (Plaquenil). They are most often used along with methotrexate. It may be weeks or months before you see any benefit from these drugs.
Corticosteroids: These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects. Therefore, they should be taken only for a short time and in low doses when possible.
Biologic agents: These drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis.
They may be given when other medicines for rheumatoid arthritis have not worked. Sometimes biologic drugs are started sooner, along with other rheumatoid arthritis drugs. However, because they are very expensive, insurance approval is generally required.
Most of them are given either under the skin or into a vein There are different types of biologic agents.
Biologic agents can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:
Surgery may be needed to correct severely damaged joints. Surgery may include:
Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong.
Sometimes, therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement.
Other therapies that may help ease joint pain include:
Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eat foods rich in fish oils (omega-3 fatty acids). Smoking cigarettes should be stopped. Excessive alcohol should also be avoided.
Most of us expect to become a little achy and creaky as we get older. It's because the cushion that protects our joints wears down over the years, a condition called osteoarthritis. But some people develop a form of arthritis at an earlier age, not because their joints are wearing away, but because their body is attacking and damaging their own joints. Let's talk about rheumatoid arthritis, or RA. The immune system normally keeps the body safe against bacteria, viruses, and other harmful invaders. But sometimes this system goes a little haywire, and the body mistakenly attacks its own tissues. That's known as an autoimmune disease. In the case of rheumatoid arthritis, the immune system attacks and damages your own joints. Like other forms of arthritis, rheumatoid arthritis makes the joints painful and stiff. If you have RA, you may notice that your joints feel stiffer in the morning, making it hard to get out of bed. Over time, you'll have trouble moving the affected joints, which can become deformed and bent out of shape. So, how do doctors diagnose rheumatoid arthritis? Well, there isn't one test that can tell for sure that you have RA. However, there are a couple of lab tests that can point your doctor to the diagnosis. You may also have an ultrasound, MRI, or x-rays so your doctor can see what's going on inside the affected joints. If you do have RA, many drugs can treat it. However, each of these drugs can have some side effects, and some of them are serious. You'll have to decide with your doctor which drug to take by weighing the benefits against the risks. If you're like most people with RA, you'll start by taking medicines called disease modifying antirheumatic drugs, or DMARDs for short. These include methotrexate. Often antimalarial drugs are given along with DMARDs. Anti-inflammatory medicines such as ibuprofen, naproxen, and celecoxib can help bring down the swelling in your joints. So can steroid drugs. If these medicines don't work, your doctor may suggest trying a biologic medicine, which targets the overactive immune response that's damaging your joints. Biologics are usually injected under the skin or into a vein. Severely deformed joints may need to be treated with surgery to remove the joint lining or even totally replace the damaged joint. Whatever treatment you use, also remember to exercise your joints on your own, or by going to a physical therapist. The right exercise can help keep your muscles strong and improve your joint mobility. When you have RA, don't try to overdo it. Think about your achy joints before doing any activity, so you don't overstress them. Also follow your doctor's treatment advice carefully. If you let this disease go, you could end up with permanent joint damage that can't be reversed. By treating RA early, you can get your joints, and the rest of you, moving more smoothly again.
Some people may benefit from taking part in an arthritis support group.
How well a person does depends on the severity of symptoms and the response to treatment. It is very important to have regular return visits to the provider, who will adjust treatment to control the arthritis.
Permanent joint damage may occur without proper treatment. Early treatment with a three-drug DMARD combination known as "triple therapy," or with the biologic drugs, can decrease joint pain and damage. These drugs are given by specialists called rheumatologists.
If not well treated, rheumatoid arthritis can affect nearly every part of the body. Complications may include:
However, these complications can most often be avoided with proper treatment. The treatments for RA can also cause serious side effects. Talk to your health care provider about the possible side effects of treatment and what to do if they occur.
Call your health care provider if you think you have symptoms of rheumatoid arthritis.
There is no known prevention. Smoking cigarettes appears to worsen RA, so it is important to avoid tobacco. Proper early treatment can help prevent further joint damage.
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Last reviewed on: 1/16/2016
Reviewed by: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.