Rheumatoid arthritis (RA) usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body. Common symptoms include stiff joints, especially when getting up after sleeping or after sitting down for a while. Some people experience fatigue and a general feeling of being unwell.
Understanding the disease
RA is an autoimmune disease, which means that a person’s immune system mistakes the body’s healthy tissues for foreign invaders. It is also a systemic disease that can affect the whole body. As the immune system responds, inflammation occurs in the target tissue or organ. This can include the joints, lungs, eyes, and heart in RA.
The Rheumatoid Arthritis Support Network estimates that RA affects up to 1% of the world’s population and over 1.3 million Americans. The incidence of RA has increased globally over the past decades and will continue to increase in the coming years. Signs and symptoms of RA usually occur in the wrists, hands, or feet and include pain, swelling, and stiffness in more than one joint, a low-grade fever, appetite loss, weight loss, tiredness, dry eyes, and chest pain.
People with RA usually experience periods when their symptoms get worse, known as flares. RA symptoms may flare up due to stress, overactivity, or stopping medications. Sometimes, a person with RA can go into remission if their symptoms go away or are mild. Most people continue to experience flares and remissions throughout their lives. Nobody knows exactly what causes the immune system to malfunction, which leads to RA. It’s thought to be a combination of genetics and environmental factors.
While other symptoms can help a person figure out if they are experiencing RA or osteoarthritis, only a doctor can diagnose these conditions. RA usually affects the same joints on both sides of the body. Pain and stiffness tend to worsen after periods of inactivity. Severe RA can lead to other complications throughout the body and cause joint damage that may lead to disability. Treatment can help manage the severity of symptoms and may reduce the likelihood of experiencing complications.
Diagnosis and treatment options
A doctor will look at the person’s clinical signs of inflammation and ask how long the person has experienced them and how severe their symptoms are. They will also perform a physical examination to check for swelling, functional limitations, or other unusual presentations. They also may recommend some tests, including blood tests, imaging scans, and X-rays.
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Several blood tests can help diagnose RA and rule out other conditions. These include anti-CCP, rheumatoid factor, erythrocyte sedimentation rate (ESR or sed rate), and C-reactive protein (CRP). Guidelines recommend the following criteria for diagnosing RA: number and location of affected joints, blood tests indicate the presence of RA, symptom duration, and inflammation indicators, or acute phase reactants. A doctor may refer a person with a diagnosis of RA to a rheumatologist, who will advise on treatment options.
Medications to manage symptoms can help relieve symptoms and slow the disease’s progression. Long-term use and high doses can lead to side effects, including bruising, gastric ulcers, high blood pressure, kidney and liver problems. Corticosteroids reduce pain and inflammation and may help slow joint damage, but they cannot cure RA. If nonsteroidal anti-inflammatory drugs (NSAIDs) do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. This can help with acute symptoms or short-term flare-ups. However, a doctor will limit steroid injections to no more than three times per year because of their impact on the soft tissue structures around the joints. More frequent injections can potentially damage these structures or cause them to tear off from where they attach to bone.
Disease-modifying antirheumatic drugs (DMARDs) affect how the immune system works. They can slow the progression of RA and prevent permanent damage to joints and other tissues by interfering with an overactive immune system. A person usually takes DMARDs for life. These types of medications are most effective if a person uses them in the early stages of RA, but it can take several weeks to a couple of months to fully experience their benefits. Some people may have to try different types of DMARDs before finding the most suitable one. Biologic treatments, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, also change how the immune system works. When the human body faces an infection or other threat, it produces TNF-alpha, an inflammatory substance. TNF-alpha inhibitors suppress this substance and help prevent inflammation.
While traditional DMARDs stop the immune system from producing immune cells that cause RA to develop, JAK inhibitors target specific signaling molecules. This helps prevent the cellular process that causes RA to progress. For the 20–30% of people living with rheumatoid arthritis who do not respond to traditional DMARDs or biologics, JAK inhibitors have proven to be an effective option. Possible side effects include a higher risk of infection, lupus, congestive heart failure, demyelinating diseases, lymphoma, and skin reactions.
Occupational or physical therapy can also play a role in managing the condition. An occupational therapist can help a person learn new and effective ways of carrying out daily tasks. This can minimize stress on painful joints. For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool. A physical therapist can advise people about using assistive devices, such as a cane, and help individuals develop a suitable exercise plan. In some cases, a doctor may recommend surgery to repair damaged joints, correct deformities, and reduce pain. Possible procedures include arthroscopic surgery, surgery to release tendons, carpal tunnel release, and arthroplasty, which is a total joint replacement surgery.
Finding time to practice self-care can help a person cope with the day-to-day challenges that RA brings. Several strategies that may help a person manage their condition include getting plenty of rest, low impact exercises such as swimming, managing weight, eating a balanced diet, applying heat or cold packs, and trying other natural remedies and complementary therapies.
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Progression and prognosis
What are the stages of rheumatoid arthritis? Stage 1: An X-ray will not show any bone or joint destruction. Stage 2: An X-ray will show the impact on the bone. Stage 3: An X-ray will show a particular kind of erosion of the cartilage and bone that a doctor can recognize as resulting from RA and deformities in the affected joints. Stage 4: The person will experience ankylosis, which is when a joint becomes stiff and fuses with the bone.
Research has determined that there are genes that make developing RA more likely. One theory is that bacteria or viruses trigger RA in people who have these genes. One of the genes that may be responsible is HLA-DR4, and it is common in people of European ancestry. However, this may not fully explain why some people get RA and others do not. There are likely environmental triggers also. Rheumatoid arthritis cannot be completely prevented, as its exact cause is not fully understood and involves a combination of genetic, environmental, and possibly hormonal factors.
According to a 2015 study, people with RA might have a 54% higher risk of mortality compared with people who do not have the condition. RA patients often face additional chronic medical conditions and complications, severely impacting their health outcomes. Notably, there is a strong association between RA and atherosclerotic cardiovascular disease, leading to accelerated coronary artery disease. However, it is difficult to predict a person’s life expectancy as the course of the disease differs significantly among individuals. With the right treatment, many people can live past the age of 80 or even 90 years while experiencing relatively mild symptoms and only minor limitations in day-to-day life.
Doctors suggest that the daily management of chronic pain is often aided by coffee drinkers have less belly fat and more muscle.
Research into how lifestyle factors impact health outcomes is ongoing.