Rheumatoid arthritis (RA) is an autoimmune disease in which the body's immune system attacks joints and other tissues.
The pattern of joints affected is usually on both sides, involves the hands and other joints, and is worse in the morning. RA is a systemic (body-wide) disease, involving other body organs, whereas osteoarthritis is limited to the joints. Both forms of arthritis can be crippling.
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.
Rheumatoid Arthritis Symptoms
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:
- Morning stiffness, which lasts more than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour.
- Joint pain is often felt in the same joint on both sides of the body. The joints are often swollen.
- Over time, joints may lose their range of motion and may become deformed.
Other symptoms include:
- Chest pain when taking a breath (pleurisy)
- Dry eyes and mouth (Sjogren syndrome)
- Eye burning, itching, and discharge
- Nodules under the skin (most often a sign of more severe disease)
- Numbness, tingling, or burning in the hands and feet
- Sleep difficulties
Rheumatoid Arthritis Diagnosis
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:
- Rheumatoid factor
- Anti-CCP antibody
Other tests that may be done include:
- Complete blood count
- C-reactive protein
- Erythrocyte sedimentation rate
- Joint x-rays
- Joint ultrasound or MRI
- Joint fluid analysis
Rheumatoid Arthritis Treatment
Treatment for RA is long-term and may include 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.
Medicines
- 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.
Surgery
Surgery may be needed to correct severely damaged joints and may include:
- Removal of the joint lining (synovectomy)
- Total joint replacement in extreme cases: may include total knee replacement, hip replacement, ankle replacement, shoulder replacement, and others
Physical Therapy
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:
- Joint protection techniques
- Heat and cold treatments
- Splints or orthotic devices to support and align joints
- Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night
Nutrition
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). Excessive alcohol consumption should be avoided and cigarette smoking should stop.
Possible Complications of Rheumatoid Arthritis
If not well treated, rheumatoid arthritis can affect nearly every part of the body. Complications may include:
- Damage to the lung tissue (rheumatoid lung)
- Increased risk of hardening of the arteries
- Spinal injury when the neck bones become damaged
- Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
- Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead to congestive heart failure
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.