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

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Causes

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 a person's genes and environment. Some causes may be:

  • 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

RA is more common in women. It often starts in people who are between 30 to 60 years of age.

Other things that may raise the risk are:

  • Having other family members with RA
  • Heavy or long-term smoking

Symptoms

Pain and swelling usually happens in smaller joints, such as the hands, wrists, and feet. It also affects joints on the same side of the body.

Other problems may be:

  • Pain, stiffness, and swelling in the morning and after inactivity that lasts more than 30 minutes
  • Red, warm joints
  • Deformed, misshapen joints
  • Lack of energy
  • Weight loss
  • Muscle aches
  • Small lumps or nodules under the skin

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. There are many diseases that have symptoms that are similar to RA. Tests will be done to rule out other health problems.

Blood tests may be done to look for inflammation and blood proteins linked to RA. Pictures may be taken to look for tissue swelling and changes in bone. This can be done with:

Samples may be taken of fluid and tissues to look for signs of RA. This can be done with:

  • Arthrocentesis—fluid from the joint
  • Synovial biopsy—a piece of the lining of the joint

Treatment

There is no cure for RA. The goal of treatment is to slow damage, ease pain, and improve movement. Steps may include:

Medicine

Medicine can help to stop or slow inflammation that causes damage to the joints. Medicine may change over time and include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and COX-2 inhibitors
  • Disease-modifying antirheumatic drugs (DMARDs) that suppress inflammation caused by immune system
  • Corticosteroids (less common)

Joint Movement and Flexibility

Physical and occupational therapy can help to keep joints flexible. They may also be able to provide tools or devices to ease stress on very weak or sore joints. Regular exercise may also be helpful.

Surgery

Surgery may be needed if there is severe damage or loss of function. It may include repair of a tendon or joint replacement.

Prevention

There are no guidelines to prevent RA.

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:

Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018 Oct 2;320(13);1360-1372.

Rheumatoid arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis. Accessed October 9, 2020.

Rheumatoid arthritis. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/rheumatoid-arthritis-ra. Accessed October 9, 2020.

Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Accessed October 9, 2020.

Rheumatoid arthritis (RA). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/rheumatoid-arthritis-ra. Accessed October 9, 2020.

Singh JA, Saag KG, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1-26.

Last reviewed September 2020 by EBSCO Medical Review Board Laura Lei-Rivera, PT, DPT, GCS  Last Updated: 5/14/2021