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Rheumatoid Arthritis

(RA; Arthritis, Rheumatoid)

Definition

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

Rheumatoid Arthritis

rheumatoid arthritis
© Nucleus Medical Media, Inc.

Causes    TOP

RA is caused by a problem with the immune system. It begins to attack healthy tissue. It is not clear what makes this happen. It is most likely a combination of factors in your genes and environment. Some known factors include:

  • Genes—people with RA often have a specific genetic defect
  • Defects in the immune system—may stop the immune cells from recognizing the body’s own tissues
  • Infection with specific viruses or bacteria—may start an abnormal immune response
  • Chemical or hormonal imbalances in the body

Risk Factors    TOP

RA is more common in:

  • Women
  • People aged 30 to 60 years

Other factors that may increase your chance of developing RA include:

  • Family members with RA
  • Heavy or long term smoking

Symptoms    TOP

Symptoms involve two or more joints which are usually:

  • Smaller joints
  • The same joints on both sides of the body

Symptoms include:

  • Increased pain and stiffness in the morning and after inactivity 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

Inflammation may also occur in:

  • Eyes
  • Mouth
  • Skin
  • Lungs
  • Blood and blood vessels

Diagnosis    TOP

The doctor will ask about your symptoms and health history. A physical exam will be done. There are many diseases that can mimic RA. Tests will help to rule out other conditions.

Tests may include:

  • Blood tests to look for:
    • Rheumatoid factor—can be found in conditions other than RA
    • Signs of an autoimmune disorder or inflammation
  • Imaging tests:
  • Tissue sample such as:
    • Synovial biopsy—a piece of the lining of the joint
    • Arthrocentesis—fluid from the joint

The doctor will look at all your symptoms and test results to reach a diagnosis.

Treatment    TOP

There is no cure for RA. The goal of treatment is to slow down the damage to the joint. It can also help:

  • Relieve pain
  • Reduce inflammation
  • Help you move better

Medicine

There are a variety of medicines to treat the pain and inflammation of RA. One or more of the following type of medicine may be recommended:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen, cyclooxgenase-2, or COX-2 inhibitors
    • May be applied to the skin or taken by mouth.
  • Disease-modifying antirheumatic drugs (DMARDs):
    • Nonbiologics—suppress the immune system
    • Biologics—attempt to repair, stimulate, or enhance the immune system
  • Corticosteroids—injected into the joint (less common)

Rest and Exercise

Rest can reduce joint inflammation and pain. It can also fight fatigue.

Exercise is important for maintaining muscle strength and flexibility. It also preserves joint motion.

  • Try mild strength training.
  • Participate in aerobic exercise. This include walking, swimming, or dancing.
  • Avoid heavy-impact exercise.
  • Try a physical therapy program.

Maintain a balance between rest and exercise.

Joint Care    TOP

Splints may help to reduce pain. Stress on joints from daily activities may be reduced with:

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

Stress Reduction    TOP

Chronic pain can be very stressful. Stress can also increase the sensation of pain and its impact on day to day life. Options to help can include:

Surgery    TOP

Surgery may be needed if there is severe damage or loss of function. Option include:

  • Replacing a joint—arthroplasty
  • Tendon reconstruction

Prevention    TOP

RA is not preventable because the cause is unknown.

RESOURCES:

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

CANADIAN RESOURCES:

The Arthritis Society
http://arthritis.ca
Canadian Rheumatology Association
http://rheum.ca

References:

Rheumatoid arthritis. Arthritis Foundation website. Available at:
...(Click grey area to select URL)
Accessed June 5, 2018.
Rheumatoid arthritis. Merck Manual Professional Version website. Available at:
...(Click grey area to select URL)
Updated February 2017. Accessed June 5, 2018.
Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at:
...(Click grey area to select URL)
Updated April 30, 2017. Accessed June 5, 2018.
Rheumatoid arthritis (RA). EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated May 2, 2018. Accessed June 5, 2018.
Tanaka E, Saito A, Kamitsuji S, 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(3):864-871.
Verstappen SM, Bijlsma JW, Verkleij H, et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys. Arthritis Rheum. 2004;51(3):488-497.
4/16/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.... 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(3):408-421.
1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: 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(10):1283-1289.
1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: 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.
Last reviewed June 2018 by EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
Last Updated: 5/13/2016

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