- Rheumatoid Arthritis (RA)
- What is rheumatoid arthritis (RA)?
- What are the signs and symptoms of RA?
- What causes RA?
- What are the risk factors for RA?
- How is RA diagnosed?
- Who should diagnose and treat RA?
- How is RA treated?
- What are the complications of RA?
- How can I manage RA and improve my quality of life?
- Learn more about RA
- Learn more about arthritis
- Frequently Asked Questions about Arthritis
- What is the patient’s role in treating or managing arthritis?
- What are the types of arthritis?
- What are bone spurs?
- What are common arthritis treatments?
- What’s new in arthritis research?
- What is rheumatoid arthritis?
- How is arthritis diagnosed and evaluated?
- Let’s Dig Into Everything about RA
- What is rheumatoid arthritis?
- Causes of Rheumatoid Arthritis
- Rheumatoid Arthritis Symptoms
- Diagnosing Rheumatoid Arthritis
- Rheumatoid Arthritis vs. Osteoarthritis
- Next steps
- Areas of the body
- Rheumatoid Arthritis
- What causes rheumatoid arthritis?
- What are the symptoms of rheumatoid arthritis?
- How is rheumatoid arthritis diagnosed?
- How is rheumatoid arthritis treated?
- Complications of Rheumatoid Arthritis
- Living with Rheumatoid Arthritis
- When should I call my healthcare provider?
- Key Points about Rheumatoid Arthritis
Rheumatoid Arthritis (RA)
What is rheumatoid arthritis (RA)?
Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body.
RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).
RA can also affect other tissues throughout the body and cause problems in organs such as the lungs, heart, and eyes.
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What are the signs and symptoms of RA?
With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.
Signs and symptoms of RA include:
- Pain or aching in more than one joint.
- Stiffness in more than one joint.
- Tenderness and swelling in more than one joint.
- The same symptoms on both sides of the body (such as in both hands or both knees).
- Weight loss.
- Fatigue, or tiredness.
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What causes RA?
RA is the result of an immune response in which the body’s immune system attacks its own healthy cells. The specific causes of RA are unknown, but some factors can increase the risk of developing the disease.
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What are the risk factors for RA?
Researchers have studied a number of genetic and environmental factors to determine if they change person’s risk of developing RA.
Characteristics that increase risk
- Age. RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
- Sex. New cases of RA are typically two-to-three times higher in women than men.
- Genetics/inherited traits. People born with specific genes are more likely to develop RA. These genes, called HLA (human leukocyte antigen) class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
- Smoking. Multiple studies show that cigarette smoking increases a person’s risk of developing RA and can make the disease worse.
- History of live births. Women who have never given birth may be at greater risk of developing RA.
- Early Life Exposures. Some early life exposures may increase risk of developing RA in adulthood. For example, one study found that children whose mothers smoked had double the risk of developing RA as adults. Children of lower income parents are at increased risk of developing RA as adults.
- Obesity. Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.
Characteristics that can decrease risk
Unlike the risk factors above which may increase risk of developing RA, at least one characteristic may decrease risk of developing RA.
- Breastfeeding. Women who have breastfed their infants have a decreased risk of developing RA.
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How is RA diagnosed?
RA is diagnosed by reviewing symptoms, conducting a physical examination, and doing X-rays and lab tests. It’s best to diagnose RA early—within 6 months of the onset of symptoms—so that people with the disease can begin treatment to slow or stop disease progression (for example, damage to joints). Diagnosis and effective treatments, particularly treatment to suppress or control inflammation, can help reduce the damaging effects of RA.
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Who should diagnose and treat RA?
A doctor or a team of doctors who specialize in care of RA patients should diagnose and treat RA. This is especially important because the signs and symptoms of RA are not specific and can look like signs and symptoms of other inflammatory joint diseases. Doctors who specialize in arthritis are called rheumatologists, and they can make the correct diagnosis. To find a provider near you, visit the database of rheumatologistsExternal on the American College of Rheumatology (ACR) website.
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How is RA treated?
RA can be effectively treated and managed with medication(s) and self-management strategies. Treatment for RA usually includes the use of medications which slow disease and prevent joint deformity, called disease-modifying antirheumatic drugs (DMARDs); biological response modifiers (biologicals) are medications that are an effective second-line treatment. In addition to medications, people can manage their RA with self-management strategies proven to reduce pain and disability, allowing them to pursue the activities important to them. People with RA can relieve pain and improve joint function by learning to use five simple and effective arthritis management strategies.
For more information about the treatment of RA, review the Clinical Practice Guidelines for the Treatment of Rheumatoid ArthritisExternal from the American College of Rheumatology (ACR) or the ACR’s Rheumatoid Arthritis Patient pageExternal.
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What are the complications of RA?
Rheumatoid arthritis (RA) has many physical and social consequences and can lower quality of life. It can cause pain, disability, and premature death.
- Premature heart disease. People with RA are also at a higher risk for developing other chronic diseases such as heart disease and diabetes. To prevent people with RA from developing heart disease, treatment of RA also focuses on reducing heart disease risk factors. For example, doctors will advise patients with RA to stop smoking and lose weight.
- Obesity. People with RA who are obese have an increased risk of developing heart disease risk factors such as high blood pressure and high cholesterol. Being obese also increases risk of developing chronic conditions such as heart disease and diabetes. Finally, people with RA who are obese experience fewer benefits from their medical treatment compared with those with RA who are not obese.
- Employment. RA can make work difficult. Adults with RA are less likely to be employed than those who do not have RA. As the disease gets worse, many people with RA find they cannot do as much as they used to. Work loss among people with RA is highest among people whose jobs are physically demanding. Work loss is lower among those in jobs with few physical demands, or in jobs where they have influence over the job pace and activities.
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How can I manage RA and improve my quality of life?
RA affects many aspects of daily living including work, leisure and social activities. Fortunately, there are multiple low-cost strategies in the community that are proven to increase quality of life.
- Get physically active. Experts recommend that ideally adults be moderately physically active for 150 minutes per week, like walking, swimming, or biking 30 minutes a day for five days a week. You can break these 30 minutes into three separate ten-minute sessions during the day. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease, diabetes, and depression. Learn more about physical activity for arthritis.
- Go to effective physical activity programs. If you are worried about making the arthritis worse or unsure how to safely exercise, participation in physical activity programs can help reduce pain and disability related to RA and improve mood and the ability to move. Classes take place at local Ys, parks, and community centers. These classes can help people with RA feel better. Learn more about the proven physical activity programs that CDC recommends.
- Join a self-management education class. Participants with arthritis and (including RA) gain confidence in learning how to control their symptoms, how to live well with arthritis, and how arthritis affects their lives. Learn more about the proven self-management education programs that CDC recommends.
- Stop Smoking. Cigarette smoking makes the disease worse and can cause other medical problems. Smoking can also make it more difficult to stay physically active, which is an important part of managing RA. Get help to stop smoking by visiting I’m Ready to Quit on CDC’s Tips From Former Smokers website.
- Maintain a Healthy Weight. Obesity can cause numerous problems for people with RA and so it’s important to maintain a healthy weight. For more information, visit the CDC Healthy Weight website.
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Learn more about RA
- National Institute of Arthritis and Musculoskeletal and Skin Diseases—Rheumatoid ArthritisExternal
- American College of Rheumatology—Rheumatoid ArthritisExternal
Learn more about arthritis
- Arthritis Types
- Physical Activity for Arthritis
- Frequently Asked Questions (FAQs)
- Arthritis-Related Statistics
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Frequently Asked Questions about Arthritis
What is the patient’s role in treating or managing arthritis?
The patient is the most important member of the health care team.
The patient plays an important role in his or her medical care. The patient can contribute to the success of a treatment plan by:
- learning about arthritis
- following through with treatment
- reporting progress and setbacks to health team
- keeping a positive attitude
- developing relationships with the rest of the health care team
Keeping a positive attitude, though sometimes difficult, is an important ingredient in overcoming arthritis. Asking questions and finding out as much as you can about of arthritis and its treatment is important. So talk over your concerns with your doctor. If you still need more information (or if you have difficulty talking to your doctor), ask the nurse, physical therapist, social worker, occupational therapist to help you find answers to your questions.
What are the types of arthritis?
Arthritis most often affects areas in or around joints. Joints are parts of the body where bones meet such as your knee. The ends of the bones are covered by cartilage, a spongy material that acts as a shock absorber to keep bones from rubbing together. The joint is enclosed in a capsule called the synovium. The synovium’s lining releases a slippery fluid that helps the joint move smoothly and easily. Muscles and tendons support the joint and help you move. Different types of arthritis can affect one or more parts of a joint. This often results in a change of shape and alignment in the joints.
Certain types of arthritis can also affect other parts of the body, such as the skin and internal organs. There are more than 100 different types of arthritis. It is important to know which type of arthritis you have so you can treat it properly. If you don’t know which type you have, call your doctor or ask during your next visit. Some common types of arthritis are described below.
The most common type of arthritis is osteoarthritis. It affects many of us as we grow older. It is sometimes called degenerative arthritis because it involves the breakdown of cartilage and bones. This causes pain and stiffness. Osteoarthritis usually affects the fingers and weight-bearing joints including the knees, feet, hips and back. It affects both men and women and usually occurs after age 45. Treatments include pain relievers or anti-inflammatory drugs, exercise, heat or cold, joint protection, pacing your efforts, self-help skills and sometimes surgery.
Fibromyalgia affects muscles and their attachments to bone. It results in widespread pain and tender points which are certain places on the body that are more sensitive to pain. It also may result in fatigue, disturbed sleep, stiffness and sometimes psychological distress. Fibromyalgia affects mostly women. It is common and often misdiagnosed. Treatments include exercise, relaxation techniques, pacing your activities and self-help skills.
In rheumatoid arthritis, a fault in the body’s defense or immune system causes inflammation or swelling. Inflammation begins in the joint lining and then damages both cartilage and bone. Rheumatoid arthritis often affects the same joints on both sides of the body. Hands, wrists, feet, knees, ankles, shoulders and elbows can be affected. Rheumatoid arthritis is more common in women than in men. Treatments include anti-inflammatory and disease-modifying drugs, exercise, heat or cold, saving energy, joint protection, self-help skills and sometimes surgery.
Gout results when the body is unable to get rid of a natural substance called uric acid. The uric acid forms needle-like crystals in the joint that cause severe pain and swelling. Gout usually affects the big toe, knees and wrists. More men than women have gout. Treatments include anti-inflammatory and special gout drugs and sometimes a diet low in purines. Foods such as organ meats, beer, wine and certain types of fish contain high levels of purines.
Low back pain
Low back pain results from a back injury or certain types of arthritis. Back pain is one of the most common health problems in the United States. It can occur at any age in both men and women. Treatments include pain relievers or anti-inflammatory drugs, exercise, heat or cold joint protection, pacing your activities and self-help skills.
Bursitis and tendinitis
Bursitis and tendinitis result from irritation caused by injuring or overusing a joint. Bursitis affects a small sac that helps muscles move easily; tendinitis affects the tendons that attach muscle to bone. Treatments include anti-inflammatory drugs heat or cold and exercise.
Other types of arthritis
There are many more types of arthritis and related diseases including ankylosing spondylitis, juvenile rheumatoid arthritis, polymyalgia rheumatica and lupus erythematosus.
What are bone spurs?
Bone spurs are of two basic types. One is the kind that arises near a joint with osteoarthritis or degenerative joint disease. In this situation, the cartilage has been worn through and the bone responds by growing extra bone at the margins of the joint surface. These “spurs” carry the formal name “osteophytes.” They are common features of the osteoarthritic shoulder, elbow, hip, knee and ankle. Removing these osteophytes is an important part of joint replacement surgery but removing them without addressing the underlying arthritis is usually not effective in relieving symptoms.
The second type of bone spur is the kind that occurs when the attachment of ligaments or tendons to bone become calcified. This can occur on the bottom of the foot around the Achilles Tendon and in the coroacoacromial ligament of the shoulder. These spurs often look impressive on X-rays, but because they are in the substance of the ligaments rarely cause sufficient problems to merit excision.
What are common arthritis treatments?
There are many things that help reduce pain, relieve stiffness and keep you moving. Your care may involve more than one kind of treatment. Your doctor may recommend medications but there are many things you can do on your own to help manage pain and fatigue and move easier.
Finding the right treatment takes time. It can involve trial and error until you and your healthcare team or therapist find what works best. Be sure to let your doctor know if a treatment is not working. Your treatment may also change as your arthritis changes.
Treatments for arthritis can be divided into several categories: medication, exercise, heat/cold, pacing, joint protection, surgery and self-help skills. You can do things in each of these areas to help yourself feel better and move easier.
Many different drugs are used to treat arthritis. Some are available without a prescription; others must be prescribed by your doctor. You should always check with your doctor before taking any medication even over-the-counter drugs. Your doctor can tell you how much and when to take them for best relief as well as how to avoid any drug-related problems.
These are some of the common medications used to treat arthritis. Your doctor may prescribe other medication to treat specific forms of arthritis or in specific situations.
Anti-inflammatories reduce both pain and swelling. These medications are called nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs such as aspirin, ibuprofen and naproxen sodium are available without a prescription; others are only available by prescription. The most common side effect of these medications is stomach upset. Call your doctor if stomach pain is more than mild and lasts.
Aspirin is commonly used to treat many forms of arthritis. Aspirin-free pain relievers may be recommended by your doctor if you just need pain relief, are allergic to aspirin or have had an ulcer. Acetaminophen gives temporary relief of common arthritis pain but does not reduce swelling. It is available without a prescription.
Corticosteroids are prescribed to reduce severe pain and swelling. They are given by injection or in pill form. Injections can bring quick relief but can only be used several times in one year because they weaken bone and cartilage. Because of potentially serious side effects, corticosteroids must be prescribed and monitored by a doctor.
Disease modifiers tend to slow down the disease process in rheumatoid arthritis. Researchers do not know how this happens. These drugs are available only by prescription and may take several weeks or months to work. Your doctor will carefully monitor you for side effects.
Sleep medications may promote deeper sleep and help relax muscles. These drugs may help people with fibromyalgia sleep better. They are available by prescription and are used in very low doses at bedtime.
Questions you should ask about your medications:
- What is its name?
- How much do I take?
- How and when do I take it?
- How long will it be before it works?
- What benefits can I expect?
- When should I contact my doctor if I don’t get relief?
- What side effects should I watch for?
- What other drugs should I not take with it?
Regular exercise is important to keep you moving and independent. Exercise helps lessen pain, increases movement, reduces fatigue and helps you look and feel better. Three types of exercises can help people with arthritis.
- Range-of-motion exercises reduce stiffness. They keep your joints flexible by moving them to their fullest extent. Most people should do these exercises daily.
- Strengthening exercises increase or maintain muscle strength. Strong muscles help keep your joints stable and make it easier to move. Most people should do these exercises daily or every other day.
- Endurance exercises build fitness. They help keep your heart healthy and control your weight. You should exercise for a total of 20 to 30 minutes three times a week at a pace that raises or sustains your heart rate. Most people can build your endurance by exercising for shorter periods of time several times a day.
Plan your exercises at times of the day when you have less stiffness or pain. Start slowly. Build up the amount of time you exercise and the number of repetitions you do. Exercise at a level that allows you to talk comfortably during the activity. If pain from exercise lasts more than two hours you may have done too much. Reduce your level of activity next time. Stop exercising right away if you have chest pains severe dizziness or shortness of breath or if you feel sick to your stomach.
Heat and cold
Using heat or cold over joints or muscles may give you short-term relief from pain and stiffness. You can also use heat or cold to help prepare for exercise. Some people feel better using heat; others prefer cold.
Heat helps relax aching muscles. Sources of heat include heating pads, hot packs, hot tubs or heated pools. Cold numbs the area so you don’t feel as much pain. You can apply cold with ice cold packs or even bags of frozen vegetables.
It’s important to use heat and cold safely. Don’t use either treatment for more than 20 minutes at a time. Let your skin return to normal temperature between applications. Don’t use heat with rubs or creams since this can result in skin burns.
For more information on using heat and cold correctly talk to your physical therapist.
Pacing yourself saves energy by switching periods of activity with periods of rest. Pacing helps protect your joints from the stress of repeated tasks and helps reduce fatigue.
Alternate heavy or repeated tasks with easy ones. Change tasks often so you don’t hold joints in one position for a long time. Plan rest breaks during your daily activities.
You can protect your joints by using them in ways that avoid excess stress. Protecting your joints makes it easier to do daily tasks.
Joint position means using joints in the best way to avoid excess stress. Use larger or stronger joints to carry things. For instance, carry your grocery bags using your forearms or palms instead of your fingers.
Walking or assistive devices can keep stress off certain joints. Your doctor may suggest using a cane crutches or a walker to reduce stress on your hips and knees.
Many assistive devices have special features that help make tasks easier. Special aids with larger handles such as extra-thick pens make it easier to hold and write. Longer handles and reachers give you better leverage. Lightweight items such as plastic dishes are easier to carry.
Weight control involves staying close to your recommended weight or losing weight if you are overweight. Weight control helps reduce your risk for developing osteoarthritis in the knees or gout. If you already have knee osteoarthritis losing weight may lessen pain by reducing stress on your joints. Exercise and reducing calories will help you lose weight. If you need to lose a lot of weight work with your doctor and a registered or licensed dietitian to find the best weight-loss program for you.
Most people with arthritis will never need surgery. However surgery can help in some cases when other treatments have failed. It can reduce pain, increase movement and improve physical appearance.
Two kinds of surgery help people with arthritis. The first kind repairs the existing joint by removing debris, fusing or correcting bone deformity. The second replaces the joint with an artificial joint.
If your doctor suggests surgery, you may want to ask another doctor for a second opinion. Orthopedic surgeons are the doctors who perform most joint replacements. Plastic surgeons may help with hand surgery.
What’s new in arthritis research?
Progress is so fast in some areas of arthritis research today that the media often report new findings before the medical journal with the information reaches your doctor’s office. As a result, you need to know how to evaluate reports on new arthritis research.
Arthritis researchers are looking at four broad areas of research. These include causes, treatments, education and prevention.
Researchers are learning more about certain conditions. For example in osteoarthritis, researchers are looking for signs of early destruction of cartilage and ways to rebuild it. For rheumatoid arthritis and other types that involve inflammation, researchers are trying to understand the steps that lead to inflammation and how it can be slowed or stopped. An initial study suggests that fibromyalgia affects more older people than originally thought and often may be overlooked in this group. Your doctor can tell you about other new research findings. If you would like to take part in arthritis research, ask your doctor for a referral to a study in your area.
Many people help make arthritis research possible. The federal government through its National Institutes of Health is the largest supporter of arthritis research. Drug companies do the most research on new medications.
Some of this material may also be available in an Arthritis Foundation brochure.
Adapted from several pamphlets originally prepared for the Arthritis Foundation, one of which is by Beth Ziebell Ph.D. This material is protected by copyright.
What is rheumatoid arthritis?
There is currently no cure for RA, but treatment can help to:
- reduce inflammation to the joints
- relieve pain
- minimize any loss of function caused by pain, joint damage, or deformity
- slow down or prevent damage to the joints
Options include medications, physical therapy, occupational therapy, counseling, and surgery.
Some drugs can help to relieve symptoms and slow disease progression.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These are available over-the-counter from pharmacies. Examples include Advil, Motrin, and Aleve. Long-term use and high doses can lead to side effects, such as bruising, gastric ulcers, high blood pressure, and kidney and liver problems.
Corticosteroids: These medications reduce pain and inflammation and may play a role in slowing down joint damage, but they cannot cure RA. If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of symptoms.
Corticosteroids can help with acute symptoms or short-term flare-ups. Long-term use of corticosteroids can have serious side effects. These include cataracts, osteoporosis, glaucoma, diabetes mellitus, and obesity.
Disease-modifying antirheumatic drugs (DMARDs)
DMARDs can slow the progression of the RA and prevent permanent damage to the joints and other tissues by interfering with the overactive immune system. A person usually takes a DMARD for life.
It is most effective if a person uses it in the early stages, but it can take from 4 to 6 months to fully experience the benefits.
Some people may have to try different types of DMARD before finding the most suitable one.
Side effects can include liver damage and immune-related problems, such as bone marrow suppression, and a higher risk of severe lung infections.
Other types of immunosuppressants include cyclosporine (Neoral, Sandimmune, Gengraf), azathioprine (Imuran, Azasan), and cyclophosphamide (Cytoxan).
Tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors)
The human body produces tumor necrosis factor-alpha (TNF-alpha), an inflammatory substance.
TNF-alpha inhibitors prevent inflammation. They can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an improvement 2 weeks after starting treatment.
Examples include (Enbrel), infliximab (Remicade) and adalimumab (Humira).
Possible side effects include:
- a higher risk of infection
- blood disorders
- congestive heart failure
- demyelinating diseases, involving an erosion of the myelin sheath that normally protects nerve fibers
An occupational therapist can help the individual learn new and effective ways of carrying out daily tasks. This can minimize stress to painful joints.
For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.
If medication and physical therapy do not help, a doctor may recommend surgery to:
- repair damaged joints
- correct deformities
- reduce pain
The following procedures are possible:
- Arthroplasty: In a total joint replacement, the surgeon removes the damaged parts and inserts a metal and plastic prosthesis, or artificial joint.
- Tendon repair: If tendons have loosened or ruptured around the joint, surgery may help restore them.
- Synovectomy: This procedure involves removal of the synovium if it is inflamed and causing pain.
- Arthrodesis: The surgeon will fuse a bone or joint to decrease pain and realign or stabilize the joint.
How is arthritis diagnosed and evaluated?
When diagnosing arthritis, your doctor will likely do a complete physical examination of your entire body, including your spine, joints, skin and eyes. You may undergo blood tests to detect markers of inflammation. In cases where an infection or gout is suspected, it may be useful to draw some fluid from a joint with a needle in order to analyze the contents of the material. In addition, your physician may order one or more of the following imaging tests:
- Bone x-ray (radiography): A radiograph (x-ray) uses a low dose of radiation to create images of internal structures. X-rays show the bones and the way they interact with each other at the joints. They are useful to evaluate the amount of cartilage at the ends of the bones, deformities and underlying conditions in the bones that may lead to arthritis, and changes in the bones that may be damage from arthritis.
- Body computed tomography (CT): CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images of the inside of the body. For people with arthritis, CT is typically used for examining joints that are deep in the body and difficult to assess with conventional x-ray, especially in the spine or pelvis.
- Musculoskeletal magnetic resonance imaging (MRI): MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of the body. The advantage of MRI is that it shows both the bones and the surrounding tissues – including cartilage, ligaments and the inner lining of the joints. MRI is frequently used to discover abnormalities in the soft tissue components of joints (which are invisible on x-ray) to determine whether treatment is effective and to look for disease complications.
- Musculoskeletal ultrasound: Ultrasound uses a small transducer (probe) and gel to create images of the body from high-frequency sound waves. It can provide detailed pictures of the joints and surrounding soft tissues, primarily those that are located near the surface of the skin.
Let’s Dig Into Everything about RA
Matthew Ezerioha, MD
Doctor of Medicine (M.D.) in 2016 from Medical University of South Carolina, Expert Medical Consultant & Entrepreneur
Sep 13, 2018 13 min read
- What is Rheumatoid Arthritis?
- The causes of RA
- Rheumatoid Arthritis symptoms
- Diagnosing RA
- Rheumatoid Arthritis (RA) vs. Osteoarthritis (OA)
- Next steps
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes pain, swelling, stiffness, and loss of function in the joints.
A healthy immune system protects the body by attacking foreign organisms such as bacteria and viruses. However, in cases where an autoimmune disease exists, the body mistakenly attacks healthy tissue instead. In RA, the joints which are designed to absorb shock and allow smooth movement between bones, are targeted by the autoimmune process.
About 1.5 million people in the United States have rheumatoid arthritis.
The ends of your bones are covered by elastic tissue called cartilage, which supports and helps protect the joints during movements. A tissue known as synovium or synovial membrane lies next to the cartilage. The synovium produces synovial fluid, a substance that acts as a lubricant and provides nourishment to the cartilage.
In people with RA, the autoimmune process causes the synovium in certain joints to become inflamed. The tissue swells and becomes painful with every movement of the affected joints.
The uncontrollable joint inflammation can also lead to joint erosion, a loss of motion, and joint damage to many associated parts of the body. In other words, people with rheumatoid arthritis will likely experience worsening pain and stiffness, especially if this particular inflammatory arthritis isn’t treated with non-steroidal anti-inflammatory medications or other standard treatment protocol.
RA affects the most important joints in the body, including joints in the:
Over time, the affected synovium along with the cartilage and bone next to it become eroded. Everything around the synovium meant to support the joint — muscles, ligaments, and tendons – slowly weaken. This breakdown, along with friction caused by a less functional synovial fluid leads to most of the pain commonly associated with RA.
The Best Rheumatoid Arthritis Treatment Begins Early
It is important to diagnose and begin treatment for rheumatoid arthritis early, as permanent damage to bones can begin within the first year of developing the disease.
For this reason, it is necessary to realize that RA often begins in middle age and nearly 3 times as many women have the condition as men. And, although it does not usually occur in children and young adults, a related disease called juvenile idiopathic arthritis (JRA) or juvenile rheumatoid arthritis (JRA) can sometimes develop.
Overall, RA is a slowly progressing disease, but once the damage is done it cannot be reversed. Therefore, doctors recommend treatment of rheumatoid arthritis beginning immediately after diagnosis to slow down the effects.
Causes of Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disorder, meaning it is caused by an anomaly in the immune system. However, doctors are not sure what causes the immune system to attack its own tissues. That being said, they have identified what likely contributes to the disease.
Certain genes may play a role in the development of RA. Since the 1970s research has shown that people with certain genetic markers are more susceptible to developing rheumatoid arthritis. The human leukocyte antigen (HLA) known as more specifically as “HLA-DRB1” was identified as a gene locus – a region or collection of genes, that is associated with RA.
Even though studies have suggested that people who have these genes could be many times more likely to develop RA than people without it, you should note that not everyone with RA has the linked HLA genes. Additionally, not everyone with the HLA gene will develop RA. These genes do not cause RA, instead they make certain patients more likely to develop it.
There are several environmental and occupational factors that, when combined with a genetic predisposition, put people at a greater risk of developing RA. Some of these factors include:
- Certain bacteria and viruses
- Exposure to second-hand smoke
- Air pollution and exposure to certain chemicals and mineral oils
- Silica mineral (found in obsidian, granite, diorite, and sandstone)
Gender: Both men and women are susceptible to RA, but the disease is far more common in women. In fact, 70 percent of people diagnosed with rheumatoid arthritis are women. This may be due to a variety of factors that are involved in the development of RA. For instance, changes (such as those caused by the use of certain contraceptives) have been linked to promoting the development of RA in people who are genetically susceptible or have been exposed to a triggering event. Rheumatoid arthritis symptoms also tend to improve or disappear completely during pregnancy, with frequent flares more common after the birth. Breastfeeding can also cause RA symptoms like joint inflammation and low-grade fever to flare.
Age: RA can affect a person at any age, but it typically presents in those between the ages of 40-60. Some cases of juvenile rheumatoid arthritis do exist though, so it’s important to be aware of this in the event that a minor starts experiencing RA-related symptoms. Remember: early detection is the key to successful treatment of rheumatic disease.
Family History: People who have a family history of rheumatoid arthritis may have a higher chance of developing the disease themselves.
Research on Rheumatoid Arthritis
In the last decade, much research has been conducted to increase our understanding of the immune system and what makes it malfunction. There have also been new therapies developed to help treat the disease. Some of the topics of intense research include:
What are the genetic factors that predispose people to develop rheumatoid arthritis?
Some white blood cells, commonly known as T cells, are important in maintaining a healthy and properly functioning immune system. However, scientists have discovered a variation—called single nucleotide polymorphism (SNP)—in a gene that controls T cells. When the SNP gene variation is present, T cells attempt to correct abnormalities in joints too quickly, causing the inflammation and tissue damage associated with RA. The discovery of SNP may help determine people’s risk for getting RA and might help explain why autoimmune diseases run in families.
At conception, twins have an identical set of genes. So why would only one twin develop RA?
Twins only have identical genomes at conception. After birth, developmental and environmental factors experienced through the stages of growth differentiate the genomes. By studying the differences in the lives of twins then, scientists can better determine where and why rheumatoid arthritis begins to develop. A technique called microarray is used to examine a large number of genes at once and find differences that may develop in cases such as those involving twins. Thanks to these types of studies, researchers have been able to identify several genes that may be associated with inflammation and bone erosion seen in people with RA.
Rheumatoid Arthritis Symptoms
Rheumatoid arthritis is a joint inflammation disease which begins slowly and progresses over time. Unfortunately, it can sometimes be difficult to detect and diagnose RA because early symptoms are often subtle and nonspecific.
A couple of these early symptoms of the disease include fatigue, stiffness, and tenderness in the joints, which can be symptoms of other, less severe conditions as well. Furthermore, symptoms appear differently in most patients and many may have periods of time where they experience no symptoms at all.
There are many other symptoms of rheumatoid arthritis that stem from inflamed tissue in the joints. Some of the most common symptoms reported by people with rheumatoid arthritis are:
- Swelling: Synovial tissue in the caps of joints becomes damaged in rheumatoid arthritis sufferers, causing the tissue to thicken and swell.
- Stiffness: Inflamed joints tend to stiffen and are difficult to move correctly. People who have RA experience stiff joints, especially in the mornings or after long periods of rest. This can last for hours at a time.
- Pain: Cartilage and bone within the joints will wear down over time. Joints are supported by surrounding muscles, ligaments and tendons, but, with RA, these will weaken and no longer stabilize joints. This causes intense pain and joint damage as a result.
- Redness: Joints can be warm and may appear pink (or even red) on the outside during a flare or when inflamed.
The degeneration caused by RA tends to affect the smaller joints in the body first, namely the joints in the fingers, hands, and feet. The damage then spreads to other major joints in the body.
Heavy inflammation of the joints is known as a flare, and flares are common in RA sufferers, sometimes lasting for months at a time.
Additionally, RA usually affects the body symmetrically, which means the same joints on both sides of the body will show symptoms at the same time. For instance, if one wrist begins showing symptoms, the other will likely show symptoms within the near future.
RA is most common in the hands, but can happen in any joint, including knees, wrists, neck, shoulders, elbows, feet, hips, and even the jaw.
Physical symptoms are the direct result of the high levels of inflammation that come with RA. These can affect the entire body and sometimes resemble the flu, but are chronic (or longer lasting) in nature.
Some of the most common physical symptoms include:
- Minor fever
- Loss of appetite
- Skin rash
- Muscle aches
- Neck pain (if the RA is in the cervical spine)
- Morning stiffness
- Weight loss
There are similar symptoms that appear in specific locations in the body.
- Shortness of breath can come from inflammation and scarring of the lungs. A sharp chest pain frequently appears as well.
- Dry eyes and dry mouth can be signs of Sjögren’s Syndrome, an immune disease that often accompanies rheumatoid arthritis. In Sjögren’s Syndrome, the glands in your eyes and mouth that typically produce mucus and moisture no longer produce effectively.
- Other eye symptoms can include burning, itchiness, discharge and impaired vision.
- Rheumatoid nodules are small lumps that form under the skin over bony areas that have been eroded away. Nodules are firm and are usually non-painful. Fortunately, the frequency of nodules in RA patients dwindles every year because of early detection and symptom control. As a result, currently only approximately 20% of rheumatoid arthritis patients have developed these nodules.
- Inflamed blood vessels from long-standing rheumatoid arthritis can lead to damage in nerves and skin resulting in numbness, tingling, and burning. This is called rheumatoid vasculitis.
- Anemia, the decrease in production of red blood cells, is also a common symptom of rheumatoid arthritis.
While physical symptoms differ in severity and frequency, sometimes the person with rheumatoid arthritis feels it in other ways. In other words, RA may also cause emotional and psychological symptoms as it affects every person differently.
For example, the symptoms of RA can leave a person unable to function for long periods of time without pain. This means that jobs which involve a large amount of moving around or a large amount of time sitting still can be difficult for a person with RA.
This type of work-based limitation can lead to mental illnesses such as depression, anxiety, low self-esteem, and feelings of helplessness. All of these psychological struggles can be fairly common among RA sufferers.
If you or someone you know is experiencing these symptoms, it’s important to see a doctor as soon as possible. Diagnosing RA early is necessary due to how quickly bone and cartilage damage can occur.
Diagnosing Rheumatoid Arthritis
Rheumatoid arthritis is subtle and often presents itself similarly to other arthritis diseases. Early symptoms include minor joint pain, stiffness, and fatigue, but these are often attributed to other, less problematic causes. For instance, sometimes symptoms will resemble the flu, making RA more difficult to detect.
However, people will typically feel the effects of RA in their smallest joints first, such as the fingers and toes. The earliest signs of the disease are:
- Achy joints
- Formation of nodules
- Unintentional weight loss
If a doctor suspects that a patient has RA, they will refer the patient to a rheumatologist for further testing. A rheumatologist is a medical professional who specializes in musculoskeletal and autoimmune diseases and is specially trained to handle the diagnosis and treatment of RA and other arthritis diseases (such as psoriatic arthritis, seronegative rheumatoid arthritis, and Felty syndrome).
Tests performed by a rheumatologist to determine whether RA exists include:
- Family history: A rheumatologist will first ask for the medical history of the patient to see if RA or other arthritis diseases run in their family. Many scientists believe that having a certain gene increases the chances of developing RA, and they also believe that gene can be inherited.
- Pain history and examination of joints: A rheumatologist can get a better understanding of disease progression if he or she knows the patient’s recent and current symptoms. That’s why it is so important to keep an accurate record of pain and other symptoms, to ensure a proper diagnosis is made. Once a rheumatologist understands a patient’s pain history, a physical examination is performed on the joints. The physical examination can tell the rheumatologist the progression of RA and where in the body it is affecting. If RA has started to develop in the joints, a patient will often show signs or sensitivity to tenderness, swelling, warmth, and painful or limited movement.
- Blood tests: Blood chemistry can tell a rheumatologist a lot about inflammation levels, making it a good determinant of rheumatoid arthritis. Put another way, if certain antibodies are present in the blood, there is a high chance that the person has RA. One of these antibodies is known as Rheumatoid factor, or RF. Rheumatoid factor is a protein which attacks healthy tissues. So, if a blood test shows that rheumatoid factor is present, there is an 80% chance the patient could develop RA or another inflammatory disease. Other blood indicators include the erythrocyte sedimentation rate (ESR), tumor necrosis factor-alpha, or c-reactive protein (CRP) levels, as all of these may indicate the presence and level of inflammation in the body.
- Imaging scans: Joint damage can be detected through imaging tests, making these useful tools for diagnosing rheumatoid arthritis. Rheumatologists use x-rays, ultrasounds, and magnetic resonance imaging scans to examine the joints and determine if RA is the cause of erosion. However, damage will not always be present with a positive RA diagnosis if the disease is in an early stage.
No single test can determine if a person has rheumatoid arthritis. Rather, rheumatologists use a combination of tests to make an accurate diagnosis. If a diagnosis is made, the patient will work with a rheumatologist to create a treatment plan that fits his or her needs and current stage of RA.
The Stages of RA
Rheumatoid arthritis most often develops as a progressive disease, meaning that it will become more aggressive over time. However, this isn’t always the case as it can also appear in other types of progressions as well.
Monocyclic progression (sometimes called remissive) is an episode of RA with symptoms that last only 2-5 years. Monocyclic progression is usually the result of an early diagnosis and immediate aggressive treatment to ensure that the symptoms do not return.
Polycyclic progression (sometimes called intermittent) is the constant recurrence of RA symptoms and flares, but in fluctuating stages. With polycyclic progression, patients can go long periods of time without experiencing any symptoms at all, but flares usually return.
Rheumatoid Arthritis vs. Osteoarthritis
Many people confuse rheumatoid arthritis with osteoarthritis (OA) due to their similar symptoms, but the two diseases are caused by different factors.
What is Osteoarthritis?
Whereas rheumatoid arthritis is an autoimmune disease that causes joint malfunction due to inflammation, osteoarthritis is a mechanical disease brought on by the destruction of joints through wear and tear.
Osteoarthritis is the most common form of arthritis, with approximately 27 million Americans over the age of 25 having been diagnosed with it. Osteoarthritis is also most commonly seen in people middle-aged to elderly and is the top cause of disability in those age groups, though it can also appear in younger people who have sustained joint injuries.
With osteoarthritis, the cartilage, joint lining, ligaments, and bone are all affected by deterioration and inflammation. When the cartilage begins to break down due to stress or changes in the body, the surrounding bones slowly get bigger and begin to fail.
Osteoarthritis is a slowly progressing disease and occurs in the joints of the hand, spine, hips, knees, and toes. Furthermore, risk factors of this disease most often stem from lifestyle or biological causes, such as:
- Old age
- Genetic recurrence or defect
- Overuse of joints
- Job stresses
- Sports injuries
Osteoarthritis sometimes occurs alongside rheumatoid arthritis or other disease, such as gout.
Symptoms of OA
Symptoms of the breakdown of joints and the weakness of bones associated with osteoarthritis include:
- Joint pain and stiffness
- Knobby swelling at the joint site
- Grinding or cracking noises at joint site during movement
- Decreased joint function
While rheumatoid arthritis occurs symmetrically in the body—meaning that when a joint on one side is affected, the joint on the other side will likely be affected as well—osteoarthritis does not occur symmetrically in the body. It affects a single joint or a joint on one side of the body more severely. It also progresses slowly over the years and can worsen with sudden injuries or increased risk factors.
When diagnosing osteoarthritis, a rheumatologist looks for warning signs that coincide with an individual’s risk factors. Physical exams, x-rays, and other imaging tests are used to determine whether a patient has osteoarthritis, as well as to determine the severity of the disease if it exists.
Like rheumatoid arthritis and other similar diseases of the joints, damage from OA cannot be reversed. However, there are treatment options and lifestyle changes that can reduce pain and improve the function of the affected joints:
- Lifestyle Changes: Being overweight is a large risk factor for osteoarthritis because it puts a large amount of stress on weight-bearing joints. This damage is largely preventable by losing excess weight and increasing safe activity. Exercise (as long as it does not put dangerous strain on the joints) can improve your muscle strength and strong muscles will better support your weight-bearing joints, ultimately lowering the chances of developing the negative symptoms of OA. Getting a sufficient amount of rest is also necessary for management of OA symptoms.
- Non-Drug Therapies: Some patients find that sore and painful joints can be soothed by holistic alternatives to drugs. Massages, chiropractic manipulation, spa visits, and acupuncture are options which are said to relieve pain, but generally only for short periods of time, or until the treatment procedure is repeated.
- Natural Home Remedies: Many sufferers have found significant pain and inflammation relief and sometimes complete remission with lab grade turmeric and boswellia combinations. These seem to be especially effective when combined with an autoimmune diet.
Osteoarthritis is treated with many of the same medications as rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease swelling and pain are often the first method of treatments. Other options include oral pain relievers such as acetaminophen and topical drugs such as capsaicin cream, lidocaine, and diclofenac gel. These drugs are typically over-the-counter, but stronger prescription medication can be prescribed by a doctor if necessary.
Prescription drugs include:
- Corticosteroids (or cortisone shots), which are often used to provide temporary relief of OA. For instance, these shots, administered directly into the knee, can delay the need for knee surgery, largely because of the relief they provide.
- Cymbalta, which is typically a drug used to treat depression, was approved by the FDA to treat chronic musculoskeletal pain, like that associated with OA.
If you or someone you care about is experiencing symptoms consistent with those associated with rheumatoid arthritis, it’s important to make an appointment with a doctor as soon as possible. The earlier RA is diagnosed, the earlier treatment can be started to minimize the long-term damage to the joints.
There are many effective medications and RA treatment options available, all of which can provide hope after a diagnosis. Some include working with a physical therapist, others involve platelet-rich plasma therapy, and still others mean something as simple as taking daily DMARDs.
DMARD is an acronym for disease-modifying antirheumatic drugs and these are medications designed to help protect the health of the joint by essentially blocking the inflammation from seeping in. Some of the most common DMARDs include Azathioprine, Leflunomide, and Methotrexate. However, there are a number of different antirheumatic drugs, medications, and other anti-inflammatory agents available for treating rheumatoid arthritis.
If you would like to know more about the various medications and treatment options available for RA, .
For helpful tips and advice about living with RA, .
Areas of the body
Arthritis and musculoskeletal pain can affect many areas of the body:
Pain that is felt in the upper part of the spine is common and is rarely due to serious disease. Staying active will help you get better faster and prevent more problems.
Pain that is felt in the shoulder area, at the top of the arm, is common and is rarely due to serious disease. Staying active will help you get better faster and prevent more problems.
Pain that is felt in the lower part of the spine is common but is rarely due to serious disease. Staying active will help you get better faster and prevent more problems.
Wrists & hands
Any joint in your fingers, thumbs, knuckles and wrists can be affected by arthritis. Many different types of arthritis can affect your hands and cause joint pain, swelling and stiffness. Find out about aids and equipment that can make everyday tasks easier. Learn ways to protect your hands and manage your symptoms.
Hips are common places to develop arthritis, especially osteoarthritis. There are many treatments for osteoarthritis of the hip that may be helpful such as weight loss, exercise, medicines, aids or supports, heat and cold and many others.
Knees are common places to develop arthritis, especially osteoarthritis. There are many treatments for osteoarthritis of the knee that may be helpful such as weight loss, exercise, medicines, aids or supports, heat and cold and many others.
Ankles & feet
Any joint in your ankles, feet and toes can be affected by arthritis. Many different types of arthritis can affect the feet and cause joint pain, swelling and stiffness. Find out about aids and equipment that can make everyday tasks easier. Learn ways to protect your hands and manage your symptoms.
Rheumatoid arthritis (RA) is a long-term (chronic) disease that causes inflammation of the joints. The inflammation can be so severe that it affects how the joints and other parts of the body look and function. In the hand, RA may cause deformities in the joints of the fingers. This makes moving your hands difficult. Lumps, known as rheumatoid nodules, may form anywhere in the body.
Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger. It causes inflammation and joint stiffness that last for more than 6 weeks. Unlike adult RA, which lasts a lifetime, children often outgrow JRA. But the disease can affect bone development in a growing child.
What causes rheumatoid arthritis?
The exact cause of RA is not known. RA is an autoimmune disorder. This means the body’s immune system attacks its own healthy cells and tissues. This causes inflammation in and around the joints. This may damage the skeletal system. RA can also damage other organs, such as the heart and lungs. Researchers think certain factors, including heredity, may be a factor.
RA most often occurs in people from ages of 30 to 50, but it can occur at any age. It happens more in women than in men.
What are the symptoms of rheumatoid arthritis?
The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease often causes inflammation in the same areas on both sides of the body. Symptoms may begin suddenly or slowly over time. Each person’s symptoms may vary, and may include:
Stiffness, especially in the morning
Swelling over the joints
Pain that is worse with joint movement
Bumps over the small joints
Trouble doing activities of daily living (ADLs), such as tying shoes, opening jars, or buttoning shirts
Trouble grasping or pinching things
Tiredness and lack of energy (fatigue)
These symptoms can seem like other health conditions. Always see your healthcare provider for a diagnosis.
How is rheumatoid arthritis diagnosed?
Diagnosing RA may be difficult in the early stages. This is because symptoms may be very mild, and signs of the disease may not be seen on X-rays or in blood tests. Your healthcare provider will take your medical history and give you a physical exam. Tests may also be done, such as:
X-ray. This test uses a small amount of radiation to create images of internal tissues, bones, and organs onto film.
Joint aspiration. For this test, a small fluid sample is taken from a swollen joint. It is done to look for signs of infection or gout.
Nodule biopsy. Tiny tissue samples are taken to look at under a microscope. This helps to check for cancer or other abnormal cells.
Blood tests. These tests are done to find certain antibodies, called rheumatoid factor, cyclic citrullinated antibody, and other signs of RA.
Ultrasound or MRI. These imaging tests can look for bone damage and inflammation.
How is rheumatoid arthritis treated?
Your healthcare provider will figure out the best treatment for you based on:
How old you are
Your overall health and medical history
How sick you are
How well you handle certain medicines, treatments, or therapies
If your condition is expected to get worse
Your opinion or preference
There is no cure for RA. The goal of treatment is often to limit pain and inflammation, and help ensure function. You may have 1 or more types of treatments. Treatment may include:
Medicines. Some medicines may be used for pain relief. Some are used to treat inflammation. Others can help to slow the disease from getting worse. Medicines should be managed by a rheumatologist. This is a doctor who specializes in arthritis and rheumatic diseases. You may need regular blood tests to check how the medicines affect your blood cells, liver, and kidneys.
Splints. Splints may be used to help protect the joints and strengthen weak joints.
Physical therapy. Physical therapy may be used to help increase the strength and movement of the affected areas.
In some cases, surgery may be an option if other treatments don’t work. Surgery does not cure RA. It helps correct the deformities caused by the disease. After surgery, RA can still cause problems. You may even need more surgery. Joint repair or reconstruction can be done in many ways, including:
Surgical cleaning. This surgery removes inflamed and diseased tissues in the hands to help increase function.
Joint replacement (arthroplasty). This type of surgery may be used in cases of severe arthritis of the hand. It may be done on older adults who are not so active. Joint replacement may reduce pain and help increase joint function. During the surgery, a joint that has been destroyed by the disease is replaced with an artificial joint. The new joint may be made out of metal, plastic, or silicone rubber. Or it may be made from your own tissue, such as a tendon from another part of your body.
Joint fusion. For this surgery, a joint is removed, and the two ends of bones are fused together. This makes one large bone without a joint. This is usually done on patients with advanced RA. After the bone fusion, the fused joint can’t move.
Complications of Rheumatoid Arthritis
Because RA damages joints over time, it causes some disability. It can cause pain and movement problems. You may be less able to do your normal daily activities and tasks. This can also lead to problems such as depression and anxiety.
RA can also affect many nonjoint parts of the body, such as the lungs, heart, skin, nerves, muscles, blood vessels, and kidneys. These complications can lead to severe illness and even death.
Living with Rheumatoid Arthritis
There is no cure for RA. But it is important to help keep your joints working well by reducing pain and inflammation. Work on a treatment plan with your healthcare provider that includes medicine and physical therapy. Work on lifestyle changes that can improve your quality of life. Lifestyle changes include:
Activity and rest. To reduce stress on your joints, switch between activity and rest. This can help protect your joints and lessen your symptoms.
Using assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and to improve balance.
Using adaptive equipment. Reachers and grabbers let you extend your reach and reduce straining. Dressing aids help you get dressed more easily.
Managing use of medicines. Medicines for this condition have some risks. Work with your healthcare provider to create a plan to reduce this risk.
Seeking support. Find a support group that can help you deal with the effects of RA.
When should I call my healthcare provider?
Tell your healthcare provider if your symptoms get worse or you have new symptoms.
Key Points about Rheumatoid Arthritis
RA is a long-term (chronic disease) that causes joint inflammation.
RA can also affect many nonjoint areas such as the lungs, heart, skin, nerves, muscles, blood vessels, and kidneys.
RA may cause deformities in the joints of the finger, making movement difficult.
The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows.
Symptoms may include joint pain, stiffness, and swelling; decreased and painful movement; bumps over small joints; and fatigue or fever.