An Overview of Rheumatoid Arthritis

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Rheumatoid arthritis is a chronic inflammatory disease that affects more than just your joints. Unlike osteoarthritis, which is caused by the long-term wear and tear of joint cartilage, rheumatoid arthritis is an autoimmune disorder in which the immune system attacks its own tissues and cells, particularly those of the joints, skin, eyes, heart, lungs, and nerves. Over time, the persistent inflammation can lead to the progressive loss of mobility, pain, and joint deformity.

While scientists have yet to find a cure for rheumatoid arthritis, medical therapy and adjunct treatments are offering relief for the estimated 1.5 million Americans living with the disease.

Symptoms

Rheumatoid arthritis primarily affects the joints. The pattern and characteristics of the disease can vary from one person to the next. For some, the symptoms will strike suddenly and severely. For others, the signs can develop gradually, often starting with a dull achiness or stiffness in the smaller joints, particularly those of the fingers or toes, before becoming progressively worse.

Over time, others joints may become affected. The pattern of involvement tends to be symmetrical, meaning that symptoms occurring on one side of the body will usually be mirrored on the other side.

The common signs and symptoms of rheumatoid arthritis include:

  • Joint and membrane tenderness, warmth, swelling, and pain
  • Fatigue, low-grade fever, and weight loss
  • Morning stiffness lasting an hour or more

As the disease progresses, joint tissues can become bonded together (tethered), resulting in a further loss of movement. The erosion and loss of cartilage, ligaments, and bone can eventually cause the joint to entirely lose it alignment and shape, resulting in severe and sometimes unsightly joint deformity. Ulnar deviation, which is finger displacement due to joint swelling, and hyperextended joints can also occur.

Other Affected Organs

The inflammation exerted by rheumatoid arthritis can adversely affect other organs as well, causing both localized and systemic (whole-body) symptoms. The most common non-joint complications include:

  • Rheumatoid nodules, hardened lumps that form under the skin, most often around the elbows, heels, or knuckles
  • Pleuritis, inflammation of the lining of the lungs, causing chest pain, shortness of breath, and rapid, shallow breathing
  • Pericarditis, inflammation of the membrane surrounding the heart, causing chest pain, chest tightness, and fatigue
  • Vasculitis, inflammation of the blood vessels, causing fever, fatigue, weight loss, and skin problems
  • Scleritis, inflammation of the white of the eye, causing redness, pain, and in severe cases, vision loss 

Rarely, nerve tissue and internal organs such as the heart may be affected.

Rheumatoid Arthritis Signs and Symptoms

Causes

As with other autoimmune diseases, the exact cause of rheumatoid arthritis is unknown. Statistically speaking, women are two to three times more likely to get the disease than men. The risk tends to increases with age, with the onset of symptoms generally occurring between the ages of 40 and 60.

Genetics appears to play a central role in the development of the most common form of the disease, accounting for between 40 percent to 65 percent of an individual's risk, according to a 2016 study published in The Lancet. While the exact mechanisms have yet to be identified, people with most autoimmune diseases are believed to have one or more genetic variations that alter the way the immune system recognizes and attacks disease-causing agents.

In a normally functioning immune system, a family of genes called the human leukocyte antigen (HLA) complex helps the immune system distinguish its own cells from those of foreign invaders, such as viruses and bacteria. With rheumatoid arthritis, certain HLA variations may inadvertently instruct the body to attack its own cells. One of the most common is a variation known as HLA-DR4.

Unsurprisingly, rheumatoid arthritis tends to run in the family. In fact, having a family history of the disease can increase your risk by three- to five-fold.

Other factors, such as obesity and smoking, can also contribute. Obesity not only places stress on affected joints, the excessive accumulation of fat cells triggers a pro-inflammatory effect. Smoking, meanwhile, can increase the risk of symptomatic disease as much as three-fold or more.

Causes and Risk Factors of Rheumatoid Arthritis

Diagnosis

There is no single lab or imaging test that can diagnose rheumatoid arthritis. To make the diagnosis, a doctor needs to review your medical history, perform a physical exam, and order a combination of lab and imaging tests.

The lab tests typically used include:

X-rays and magnetic resonance imaging (MRI) can be used throughout the course of the disease to evaluate its progression and monitor the effectiveness of treatment.

How Rheumatoid Arthritis Is Diagnosed

Treatment

While there is no cure for rheumatoid arthritis, the introduction of newer biologic drugs has given hope to those who have failed to find relief with traditional pain relievers and steroids. Treatment today usually includes a combination of medication types.

Among them:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) can help alleviate the pain and inflammation of mild to moderate rheumatoid arthritis. Stronger NSAIDs are available by prescription. Side effects include stomach irritation, high blood pressure, stomach ulcers, liver toxicity, and increased risk of stroke or heart attack.
  • Corticosteroid drugs, such as prednisone, can provide short-term relief of pain and inflammation while slowing joint damage. Side effects may include osteoporosis, weight gain, easy bruising, cataracts, glaucoma, and diabetes.
  • Disease-modifying antirheumatic drugs (DMARDs) work by tempering the immune response and slowing the progression of the disease. Common DMARDs include methotrexate, Arava (leflunomide), Azulfidine (sulfasalazine), and Plaquenil (hydroxychloroquine). Side effects may include an increased risk of infection and liver damage.
  • Biologic response modifiers are a newer class of DMARDs usually used in combination with methotrexate. They include includes Cimzia (certolizumab), Enbrel (etanercept), Humira (adalimumab), Orencia (abatacept), and Remicade (infliximab). Unlike earlier generation DMARDs, biologics target specific components of the immune system rather than the immune system as a whole. Side effects include an increased risk of infection.

    Physiotherapy is also an integral part of rheumatoid arthritis treatment and may use heat, ice, transcutaneous electrical stimulation, ultrasound, range-of-motion exercises, and gentle strengthening exercises. Occupational therapy may also be helpful if the arthritis is interfering with your daily life or ability to work.

    A number of complementary and alternative medicines (CAMs), such as fish oil, borage, and evening primrose have proven beneficial in supporting treatment of mild to moderate rheumatoid arthritis.

    How Rheumatoid Arthritis Is Treated

    Coping

    Rheumatoid arthritis is a life-long progressive disease that can diminish your quality of life and self-confidence if you let it. By taking proactive steps to improve your health, you can better cope and overcome some of the more challenging aspects of the disease.

    In addition to medications, weight loss and exercise can help improve your mobility and better sustain your range of motion. Even if you are already experiencing impairment, low-impact exercises like walking, swimming, biking, yoga, and Tai Chi can keep the joints moving without placing undue stress on joint tissues.

    Similarly, mind-body therapies can be effective in helping you cope with the pain, fatigue, and anxiety that are often part and parcel of the disease. Options include meditation, biofeedback, breathing exercises, and guided imagery. By better managing your emotional response to your symptoms, you may not only achieve a greater sense of calm, but better pain control.

    Rheumatoid Arthritis Support and Resources

    A Word From Verywell

    Rheumatoid arthritis can often be isolating to people severely affected by the disease. It may not only restrict your ability to engage in everyday activities, it can affect your confidence and self-image as the physical manifestations of the disease become more apparent.

    Do not allow yourself or a loved one go it alone. Speak with friends or family and let them know what you are going through. Many people simply don't understand what rheumatoid arthritis is or the challenges people living with the disease regularly face. The more you open up and help them understand, the abler they will be to support you. It also helps to reach out to others who are also affected by rheumatoid arthritis. 

    Pain and Swelling Could Mean Rheumatoid Arthritis
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