What is Rheumatoid Arthritis? Symptoms & Treatment

Rheumatoid Arthritis (RA):

Rheumatoid arthritis is a type of arthritis where your immune system attacks the tissue lining the joints on both sides of your body. It may affect other parts of your body too. The exact cause is unknown. Treatment options include lifestyle changes, physical therapy, occupational therapy, nutritional therapy, medication and surgery.  

What is rheumatoid arthritis?

 Rheumatoid arthritis (RA) is an autoimmune disease that is chronic (ongoing). It occurs in the joints on both sides of your body, which makes it different from other types of arthritis. You may have symptoms of pain and inflammation in your:

-       Fingers.

-       Hands.

-       Wrists.

-       Knees.

-       Ankles.

-       Feet.

-       Toes.

 Uncontrolled inflammation damages cartilage, which normally acts as a “shock absorber” in your joints. In time, this can deform your joints. Eventually, your bone itself erodes. This can lead to the fusion of your joint (an effort of your body to protect itself from constant irritation).  

Specific cells in your immune system (your body’s infection-fighting system) aid this process. These substances are produced in your joints, but also circulate and cause symptoms throughout your body. In addition to affecting your joints, rheumatoid arthritis sometimes affects other parts of your body, including your:

-       Skin. 

-       Eyes. 

-       Mouth. 

-       Lungs. 

-       Heart.  

What’s the age of onset for rheumatoid arthritis?

RA usually starts to develop between the ages of 30 and 60. But anyone can develop rheumatoid arthritis. In children and young adults, usually between the ages of 16 and 40, it’s called young-onset rheumatoid arthritis. In people who develop symptoms after they turn 60, it’s called later-onset rheumatoid arthritis (LORA). 

What are the symptoms of rheumatoid arthritis?

 Rheumatoid arthritis affects everyone differently. In some people, joint symptoms develop over several years. In other people, rheumatoid arthritis symptoms progress rapidly. Many people have time with symptoms (flares) and then time with no symptoms (remission). 

 Symptoms of rheumatoid arthritis include:

-      Pain, swelling, stiffness and tenderness in more than one joint. 

-      Stiffness, especially in the morning or after sitting for long periods. 

-      Pain and stiffness in the same joints on both sides of your body. 

-      Fatigue (extreme tiredness). 

-      Weakness. 

-      Fever.

 Does rheumatoid arthritis cause fatigue?

 Everyone’s experience of rheumatoid arthritis is a little different. But many people with RA say that fatigue is among the worst symptoms of the disease.  

Living with chronic pain can be exhausting. And fatigue can make it more difficult to manage your pain. It’s important to pay attention to your body and take breaks before you get too tired.   

What are rheumatoid arthritis flare symptoms?

 The symptoms of a rheumatoid arthritis flare aren’t much different from the symptoms of rheumatoid arthritis. But people with RA have ups and downs. A flare is a time when you have significant symptoms after feeling better for a while. With treatment, you’ll likely have periods of time when you feel better. Then, stress, changes in weather, certain foods or infections trigger a period of increased disease activity. 

Although you can’t prevent flares altogether, there are steps you can take to help you manage them. It might help to write your symptoms down every day in a journal, along with what’s going on in your life. Share this journal with your rheumatologist, who may help you identify triggers. Then you can work to manage those triggers.  

What causes rheumatoid arthritis?

 The exact cause of rheumatoid arthritis is unknown. Researchers think it’s caused by a combination of genetics, hormones and environmental factors.  

Normally, your immune system protects your body from disease. With rheumatoid arthritis, something triggers your immune system to attack your joints. An infection, smoking or physical or emotional stress may be triggering.   

Is rheumatoid arthritis genetic?

 Scientists have studied many genes as potential risk factors for RA. Certain genetic variations and non-genetic factors contribute to your risk of developing rheumatoid arthritis. Non-genetic factors include gender and exposure to irritants and pollutants. 

People born with variations in the human leukocyte antigen (HLA) genes are more likely to develop rheumatoid arthritis. HLA genes help your immune system tell the difference between proteins your body makes and proteins from invaders like viruses and bacteria.  

What are the risk factors for developing rheumatoid arthritis?

 There are several risk factors for developing rheumatoid arthritis. These include:

-    Family history: You’re more likely to develop RA if you have a close relative who also has it.

-    Gender: Women are two to three times more likely to develop rheumatoid arthritis.

-    Smoking: Smoking increases a person’s risk of rheumatoid arthritis and makes the disease worse.

-       Obesity: Your chances of developing RA are higher if you have obesity. 

How is rheumatoid arthritis diagnosed?

 Your healthcare provider may refer you to a physician who specializes in arthritis (rheumatologist). Rheumatologists diagnose people with rheumatoid arthritis based on a combination of several factors. They’ll do a physical exam and ask you about your medical history and symptoms. Your rheumatologist will order blood tests and imaging tests.

The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid arthritis. These may include: 

-       Erythrocyte Sedimentation Rate (ESR) confirms inflammation in your joints.  

-       C-reactive protein (CRP). 

-       About 80% of people with RA test positive for rheumatoid factor (RF). 

-       About 60% to 70% of people living with rheumatoid arthritis have antibodies to cyclic cItrullinated peptides (CCP) (proteins).   

Your rheumatologist may order imaging tests to look for signs that your joints are wearing away. Rheumatoid arthritis can cause the ends of the bones within your joints to wear down. The imaging tests may include: 

-       X-rays. 

-       Ultrasounds. 

-       Magnetic resonance imaging (RMI) scans.   

In some cases, your doctor may watch how you do over time before making a definitive diagnosis of rheumatoid arthritis.  

What are the diagnostic criteria for rheumatoid arthritis?

 Diagnostic criteria are a set of signs, symptoms and test results your doctor looks for before telling you that you’ve got rheumatoid arthritis. They’re based on years of research and clinical practice. Some people with RA don’t have all the criteria. Generally, though, the diagnostic criteria for rheumatoid arthritis include:    

• Inflammatory arthritis in two or more large joints (shoulders, elbows, hips, knees and ankles).
• Inflammatory arthritis in smaller joints. 
• Positive biomarker tests like rheumatoid factor (RF) or CCP antibodies. 
• Elevated levels of CRP rate. 
• Your symptoms have lasted more than six weeks.   

What are the goals of treating rheumatoid arthritis?

 The most important goal of treating rheumatoid arthritis is to reduce joint pain and swelling. Doing so should help maintain or improve joint function. The long-term goal of treatment is to reduce the pace or stop joint damage. Controlling joint inflammation reduces your pain and improves your quality of life. 

How is rheumatoid arthritis treated?

 Joint damage generally occurs within the first two years of diagnosis, so it’s important to see your doctor if you notice symptoms. Treating rheumatoid arthritis in this “window of opportunity” can help prevent long-term consequences. 

Treatments for rheumatoid arthritis include lifestyle changes, therapies, medicine and surgery. Your doctor considers your age, health, medical history and how bad your symptoms are when deciding on a treatment.  

What medications treat rheumatoid arthritis?

 Early treatment with certain drugs can improve your long-term outcome. Combinations of drugs may be more effective than, and appear to be as safe as, single-drug therapy. 

There are many medications to decrease joint pain, swelling and inflammation, and to prevent or slow down the disease.  

The safest drug for rheumatoid arthritis is one that gives you the most benefit with the least amount of negative side effects. This varies depending on your health history and the severity of your RA symptoms. Your doctor will work with you to develop a treatment program. The drugs your healthcare provider prescribes will match the seriousness of your condition. 

It’s important to meet with your healthcare provider regularly. They’ll watch for any side effects and change your treatment, if necessary. Your healthcare provider may order tests to determine how effective your treatment is and if you have any side effects. 

Will changing my diet help my rheumatoid arthritis?

 When combined with the treatments and medications your provider recommends, changes in diet may help reduce inflammation and other symptoms of RA. But it won’t cure you. You can talk with your doctor about adding good fats and minimizing bad fats, salt and processed carbohydrates. No herbal or nutritional supplements, like collagen, can cure rheumatoid arthritis. These dietary changes are safer and most successful when monitored by your rheumatologist.

 But there are lifestyle changes you can make that may help relieve your symptoms. Your rheumatologist may recommend weight loss to reduce stress on inflamed joints.   

People with rheumatoid arthritis also have a higher risk of coronary artery disease. High blood cholesterol (a risk factor for coronary artery disease) can respond to changes in diet. A nutritionist can recommend specific foods to eat or avoid reaching a desirable cholesterol level.  

When is surgery used to treat rheumatoid arthritis?

 Surgery may be an option to restore function to severely damaged joints. Your provider may also recommend surgery if your pain isn’t controlled with medication. Surgeries that treat RA include:

-       Knee replacement.

-       Hip replacement.

-       Other surgeries to correct a deformity. 

What is the prognosis (outlook) for people who have rheumatoid arthritis?

 Although there’s no cure for rheumatoid arthritis, there are many effective methods for decreasing your pain and inflammation and slowing down your disease process. Early diagnosis and effective treatment are very important. 

What types of lifestyle changes can help with rheumatoid arthritis?

 Having a lifelong illness like rheumatoid arthritis may make you feel like you don’t have much control over your quality of life. While there are aspects of RA that you can’t control, there are things you can do to help you feel the best that you can. 

Such lifestyle changes include:  

Rest

 When your joints are inflamed, the risk of injury to your joints and nearby soft tissue structures (such as tendons and ligaments) is high. This is why you need to rest your inflamed joints. But it’s still important for you to exercise. Maintaining a good range of motion in your joints and good fitness overall are important in coping with RA. 

Exercise 

Pain and stiffness can slow you down. Some people with rheumatoid arthritis become inactive. But inactivity can lead to a loss of joint motion and loss of muscle strength. These, in turn, decrease joint stability and increase pain and fatigue. 

Regular exercise can help prevent and reverse these effects. You might want to start by seeing a physical or occupational therapist for advice about how to exercise safely. Beneficial workouts include: 

-       Range-of-motion exercises to preserve and restore joint motion. 

-       Exercises to increase strength. Exercises to increase endurance (walking, swimming and cycling). 

The best way to handle your RA is to consult/visit your rheumatologist on regular basis and follow his/her advice