Arthritis, Rheumatoid

Felty's Syndrome
Felty's Syndrome


Rheumatoid arthritis (RA) is a disease that leads to inflammation of the joints and surrounding tissues. It is a long-term disease. It can also affect other organs.


The cause of RA is not known. It is an autoimmune disease. This means the immune system of the body 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 less common than osteoarthritis (OA). OA 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. Fingers, wrists, knees, feet, elbows, ankles, hips, and shoulders are the most commonly affected.

The disease often begins slowly. Early symptoms may include:

  • Minor joint pain

  • Stiffness

  • 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.

  • 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 (Sjögren 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

The diagnosis of RA is made when:

  • You have pain and swelling in 3 or more joints.

  • Arthritis has been present for longer than 6 weeks.

  • You have a positive test for rheumatoid factor or anti-CCP antibody.

  • You have elevated ESR or CRP.

  • Other types of arthritis have been ruled out.

  • Sometimes the diagnosis of RA is made even without all of the conditions shown above if the arthritis is otherwise typical for RA.

Exams & Tests

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 are positive in most people and often help in the diagnosis are:

  • Rheumatoid factor

  • Anti-CCP antibody

  • These tests are positive in most patients with RA. The anti-CCP antibody test is more specific for RA.

Other tests that may be done include:

  • Complete blood count

  • Metabolic panel and uric acid

  • C-reactive protein (CRP)

  • Erythrocyte sedimentation rate (ESR)

  • Antinuclear antibody

  • Tests for hepatitis

  • Joint x-rays

  • Joint ultrasound or MRI

  • Joint fluid analysis


RA most often requires long-term treatment by an expert in arthritis called a rheumatologist. Treatment includes:

  • Medicines

  • Physical therapy

  • Exercise

  • Education to help you understand the nature of RA, your treatment options, and the need for regular follow-up.

  • Surgery, if required

  • Early treatment for RA with medicines called disease-modifying antirheumatic drugs (DMARDS) should be used in all patients. This will slow joint destruction and prevent deformities. The activity of the RA should be checked at regular visits to make sure the disease is under control. The goal of treatment is to stop the progression of the RA.


Anti-inflammatory medicines: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib.

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.

Since they do not prevent joint damage if used alone, DMARDS should be used as well.

Disease-modifying antirheumatic drugs (DMARDs): These are often the medicines that are tried first in people with RA. They are prescribed along with rest, strengthening exercise, and anti-inflammatory drugs.

Methotrexate is the most commonly used DMARD for rheumatoid arthritis. Leflunomide and hydroxychloroquine may also be used.

Sulfasalazine is a drug that is often combined with methotrexate and hydroxychloroquine (triple therapy).

It may be weeks or months before you see any benefit from these drugs.

These drugs may have serious side effects, so you will need frequent blood tests when taking them.

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 DMARD agents — These medicines are designed to affect parts of the immune system that play a role in the disease process of RA.

They may be given when other medicines, usually methotrexate, have not worked. Biologic drugs are often added to methotrexate. 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 now many different types of biologic agents.

Biologic and synthetic agents can be very helpful in treating RA. However, people taking these medicines must be watched closely because of uncommon, but serious adverse reactions:


Surgery may be needed to correct severely damaged joints. Surgery may include:

Removal of the joint lining (synovectomy)

Total joint replacement, in extreme cases, may include total knee replacement (TKR) and hip replacement.


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


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.


Courtesy of MedlinePlus from the National Library of Medicine