Rheumatoid Arthritis, also known as RA, is a type of chronic inflammatory arthritis that affects between 1 & 2 million Americans (see previous blog post on inflammatory arthritis). RA can affect more than just the joints, often causing damage to a wide variety of body systems such as the skin, eyes, lungs, heart, and blood vessels.
Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. The inflammation associated with RA is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe RA can still cause physical disabilities.
Signs and symptoms of rheumatoid arthritis may include:
Tender, warm, swollen joints
Joint stiffness that is usually worse in the mornings and after inactivity
Fatigue, fever and loss of appetite
Early RA tends to affect smaller joints first, particularly the joints that attach your fingers to your hands and your toes to your feet.
As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.
About 40% of people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Areas that may be affected include:
Skin
Eyes
Lungs
Heart
Kidneys
Salivary glands
Nerve tissue
Bone marrow
Blood vessels
The presence of RA signs and symptoms may vary in severity and location, and can even come and go (referred to as flares). Some people develop severe, sudden pain while others have very mild symptoms. Periods of increased disease activity (flares) alternate with periods of relative remission, where pain & swelling decrease or disappear. Onset of the disease is usually gradual, but symptoms may progress rapidly, so early diagnosis and treatment is crucial to limiting the scope of potential joint damage. Over time, RA can cause joints to deform and shift out of place.
Rheumatoid arthritis is an autoimmune disease. Normally, your immune system helps protect your body from infection and disease. In RA, your immune system attacks healthy tissue in affected joints and body structures.
Doctors don't know what starts this process, although a genetic component appears likely. While genes don't actually cause RA, they can make you more likely to react to environmental factors, such as infection with certain viruses and bacteria that may trigger the disease.
Factors that may increase your risk of rheumatoid arthritis include:
Sex. Women are more likely than men to develop rheumatoid arthritis.
Age. Rheumatoid arthritis can occur at any age, but it most commonly begins in middle age.
Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
Excess weight. People who are overweight appear to be at a somewhat higher risk of developing rheumatoid arthritis.
Complications
Rheumatoid arthritis increases your risk of developing:
Osteoporosis. RA itself, along with some medications used for treatment, can increase your risk of osteoporosis, a condition that weakens bones and makes them more prone to fracture.
Rheumatoid nodules. These firm bumps of tissue most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the heart and lungs.
Dry eyes and mouth. People who have RA are much more likely to develop Sjogren's syndrome, a disorder that decreases the amount of moisture in the eyes and mouth.
Infections. RA itself & many of the medications used to combat it can impair the immune system, leading to increased infections. Protect yourself with vaccinations to prevent diseases such as influenza, pneumonia, shingles and COVID-19.
Abnormal body composition. The proportion of fat to lean mass is often higher in people who have RA, even in those who have a normal body mass index (BMI).
Carpal tunnel syndrome. If RA affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
Heart problems. RA can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
Lung disease. People with RA have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
Lymphoma. RA increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.
Diagnosis
Rheumatoid arthritis can be difficult disease to diagnose in early stages, as signs & symptoms often mimic those of many other diseases. There is no one blood test to confirm presence of RA, so accurate diagnosis requires a combination of medical history, physical exam, laboratory testing, and imaging studies.
Blood tests: People with RA often have an elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
Imaging tests: Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body.
During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength.
Treatment
There is no cure for RA, but clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (DMARDs).
Therapy
Your doctor may refer you to a physical or occupational therapist who can teach you gentle exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks that will be easier on your joints and conserve energy. Check out our previous blog post on joint protection techniques!
Assistive devices can make it easier to avoid stressing painful joints. For instance, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Ask your therapist for recommendations for adaptive equipment and techniques.
In extreme cases, if medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and improve function.
[Photo: Mount Sinai. (2020). Rheumatoid arthritis. https://www.mountsinai.org/health-library/diseases-conditions/rheumatoid-arthritis]
References
Arthritis Health. (2011, January 11). Inflammatory arthritis. Veritas Health, LLC. https://www.arthritis-health.com/types/general/inflammatory-arthritis
Mayo Clinic. (2021, May 18). Rheumatoid arthritis. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
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