Rheumatoid Arthritis

(RA; Arthritis, Rheumatoid)

Definition

Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints.

Rheumatoid Arthritis

rheumatoid arthritis
© 2011 Nucleus Medical Media, Inc.

Causes    TOP

RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include:

  • Genes—People with rheumatoid arthritis may have a specific genetic defect that increases their risk for developing this condition.
  • Defects in the immune system may cause the immune cells to fail to recognize the body’s own tissues.
  • Infection with specific viruses or bacteria that kick off an abnormal immune response.
  • Chemical or hormonal imbalances in the body.

Risk Factors    TOP

RA is more common in women, and in people between the ages of 30 and 60. Other factors that may increase your chance of developing RA include:

  • Family members with RA
  • Excess weight or obesity
  • Heavy or long-term smoking

Symptoms    TOP

RA causes many symptoms.

Joint symptoms include:

  • Increased pain and stiffness in the morning and after inactivity
  • Morning stiffness and pain that lasts more than 30 minutes
  • Red, swollen, warm joints
  • Deformed, misshapen joints

RA may also cause:

  • Intense fatigue, decreased energy
  • Muscle aches
  • Decreased appetite
  • Weight loss
  • Fever and sweats
  • Insomnia
  • Small lumps or nodules under the skin

Conditions associated with RA include:

  • Sjogren's syndrome —an inflammatory condition involving the tear and salivary glands
  • Felty syndrome—three conditions marked by rheumatoid arthritis, enlarged spleen, and low levels of white blood cells
  • Caplan syndrome—marked by rheumatoid arthritis and pneumoconiosis (lung disease in people exposed to coal mining dust or asbestos)
  • Osteoporosis
  • Osteoarthritis
  • Raynaud's disease and phenomenon
  • Muscle inflammation
  • Muscle weakness
  • Kidney disease

Diagnosis    TOP

The doctor will ask about your symptoms and medical history. A physical exam will be done. To be diagnosed with RA, you must have at least one swollen or tender joint or a history of a swollen joint. How many joints, and which joints are involved, will help aid your doctor in the diagnosis. The doctor will also rule out other conditions that may have similar symptoms.

Tests may include:

  • Blood tests to determine if you have an autoimmune disease
  • Imaging tests, such as x-rays, or an MRI scan or ultrasound

Treatment    TOP

There is no cure for RA. The goals of treatment are to:

  • Relieve pain
  • Reduce inflammation
  • Slow down joint damage
  • Improve functional ability

Medications

There are a variety of medications to treat the pain and inflammation of RA. In some cases, medications may be used in combination. These may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Cyclooxgenase-2 or COX-2 inhibitors
  • Nonbiologic disease-modifying antirheumatic drugs (DMARDs)
  • Biologic disease-modifying antirheumatic drugs (DMARDs)
  • Corticosteroids

Medication may be taken by mouth, applied to the skin, or injected into the joint.

Rest and Exercise

Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.

These steps may help relieve stiffness, weakness, and reduce inflammation:

  • Maintain a balance between rest and exercise
  • Attempt mild strength training
  • Participate in aerobic exercise, such as, walking, swimming, or dancing
  • Avoid heavy-impact exercise
  • Control weight
  • Participate in a physical therapy program

Joint Care    TOP

Splints applied to painful joints may reduce pain. Devices that help with daily activities can also reduce stress on joints. Devices include:

  • Zipper extenders
  • Long-handled shoehorns
  • Specially designed kitchen tools

Stress Reduction    TOP

Stress reduction can ease the difficulties of living with a chronic, painful disease. Participating in an exercise program or joining a support group are two strategies you can use to reduce stress. Cognitive behavioral therapy, a form of talk therapy, and meditation may also offer benefits in reducing your pain and improving your ability to cope with RA.

Surgery    TOP

Joint replacement and tendon reconstruction help relieve severe joint damage.

Prevention    TOP

There are no current guidelines to prevent RA.

RESOURCES:

American College of Rheumatology
http://www.rheumatology.org
Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Rheumatology Association
http://rheum.ca

References:

Rheumatoid arthritis. Arthritis Foundation website. Available at:
...(Click grey area to select URL)
Accessed August 21, 2013.
Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at:
...(Click grey area to select URL)
Updated April 2009. Accessed August 21, 2013.
Rheumatoid arthritis (RA). EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated July 2, 2013. Accessed August 21, 2013.
Who gets RA? Arthritis Foundation website. Available at:
...(Click grey area to select URL)
Accessed August 21, 2013.
Tanaka E, Saito A, et al. Impact of shoulder, elbow, and knee joint involvement on assessment of rheumatoid arthritis using the American College of Rheumatology Core Data Set. Arthritis Rheum. 2005;53:864-871.
Verstappen SM, Bijlsma JW, et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthritis Rheum. 2004;51:488-497.
4/16/2009 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Zautra AJ, Davis MC, Reich JW, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76:408-421.
1/4/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Anis A, Zhang W, Emery P, et al. The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Rheumatology (Oxford). 2009;48:1283-1289.
1/4/2011 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Aletaha D, Neogi T, Silman AJ, Funovits J, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580-1588.
4/24/2014 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed April 24, 2014.
Last reviewed June 2013 by Fahran Tahir, MD
Last Updated: 4/24/2014