Rheumatoid Arthritis (RA) is a form of arthritis that causes pain, swelling, stiffness, and loss of function in your joints. It can affect any joint but is common in the wrist and fingers.
More women than men get rheumatoid arthritis. It often starts in middle age and is most common in older people. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime.
Rheumatoid arthritis is different from osteoarthritis, common arthritis that often comes with older age. RA can affect body parts besides joints, such as your eyes, mouth, and lungs. RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body’s own tissues.
No one knows what causes rheumatoid arthritis. Genes, environment, and hormones might contribute. Treatments include medicine, lifestyle changes, and surgery. These can slow or stop joint damage and reduce pain and swelling.
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.
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
RA most often requires long-term treatment by an expert in arthritis called a rheumatologist. Treatment includes:
• Physical therapy
• 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:
• Infections from bacteria, viruses, and fungi
• Skin cancer, but not melanoma
• Skin reactions
• Allergic reactions
• Worsened heart failure
• Damage to nerves
• Low white blood cell count
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.
Exams and 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