Causes of Rheumatoid Arthritis Pain and Treatment Options

Rheumatoid arthritis (RA) is one of the most common types of inflammatory arthritis in comparison to osteoarthritis, which is far more common, but non-inflammatory. Like other forms of arthritis, RA can cause your joints to swell and hurt. While RA can impact many joints throughout the body, it often starts in the hands and fingers, which makes grasping objects or opening containers difficult.

One of the first symptoms of RA can be prolonged morning stiffness. Initial arthritis pain may feel like a dull ache or a deep, burning sensation. More progressed arthritis may cause you to feel stiff or sore when you sit down or bend over, and you may have trouble clenching and unclenching your fingers or bending your knees.

RA is an autoimmune condition, so it can impact more than a person’s joints. Unlike osteoarthritis, RA isn't caused by the normal wear and tear on an aging musculoskeletal system. RA pain can be complicated, but patients might find better coping strategies when they learn more about rheumatoid arthritis and its symptoms.

What Causes RA Pain?

Medical researchers remain uncertain about which factors definitely lead to the condition. Certain people have a higher risk of developing the disease, such as women, those with a family history of the disease, and people age 60 or over. Environmental and lifestyle factors also play a role, as smokers are more at risk than non-smokers.

What we do know, though, is that rheumatoid arthritis forces a person’s immune system to attack their own joints and tissues—namely, the lining of their joints called the synovium. The synovium is a soft tissue layer that cushions and connects your joints. Your synovium helps your knees, shoulders, and wrists move easily and freely.

In RA, the synovium first becomes inflamed. The influx of inflammatory cells comes along with cell proliferation, which causes thickening, and this restricts joint movement.

Some people describe their RA pain as an ache, a burn, a tingling, or a twisting sensation. However, RA also can present several non-pain related symptoms.

In severe cases, rheumatoid arthritis can cause symptoms outside of the joints. In fact, almost half of RA patients report that the condition impacts other parts of their bodies, especially their lungs. RA patients may find that they have difficulty catching their breath or breathing deeply.

About 25% of people with the condition develop firm lumps under their skin, called rheumatoid nodules. These nodules may appear near bony areas like on your hands or your elbows. 

As with many other inflammatory and autoimmune diseases, rheumatoid arthritis can impact many parts of the body, and different people report different symptoms. Always check with your healthcare provider to receive a formal diagnosis. 

Other Causes

Certain situations can cause RA to flare. For example, weather changes like shifting seasons or incoming storms can result in higher or lower atmospheric pressures. These changing pressures can irritate inflamed joints. Cold weather, especially, can cause joints to feel stiff. 

Physical and psychological stress can also exacerbate your RA symptoms. Stress actually sets off the immune system’s inflammatory response and can cause a flare.

If your body is fighting an infection, that will impact your autoimmune system. Because RA is an autoimmune disorder, your immune system may attack its own joints as it is trying to fight off a bacterial or viral infection. Therefore, other infections or illnesses can trigger or worsen your normal RA symptoms.

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Treating RA Pain

Prescription Medications

Your healthcare provider may prescribe a disease-modifying antirheumatic drug (DMARD), such as methotrexate. These drugs help suppress an overactive immune system, which prevents your body from attacking your joints. DMARDs can be used in oral, self-injectable, or IV infusion form.

With these medicines, people may notice less joint inflammation, which can prevent long-term bone and tissue damage. DMARDs are used specifically for rheumatoid conditions like RA or connective tissue diseases. 

To help alleviate pain, many patients use nonsteroidal anti-inflammatory drugs (NSAIDs). Some common NSAID pain relievers include Advil, Motrin, and Aleve. Potential side effects of NSAIDs include kidney damage and the development of gastritis/peptic ulcer disease. These drugs can also increase the risk of cardiovascular events such as heart attack and stroke.

Tylenol (acetaminophen) is more often recommended for pain control, especially in older people and those with underlying renal disease.

Occasionally, your healthcare provider may prescribe a more powerful narcotic pain reliever, such as hydrocodone. These medications can help provide relief from severe pain.

Most effective for a true flare are steroids (prednisone), which would address the underlying inflammation, not just the pain. However, it is recommended that the use of steroids be limited as much as possible due to their potential side effects.

Home Remedies

People with mild to moderate RA often use home remedies as part of their treatment plan. Warmth can help reduce stiffness and alleviate aches. Heated blankets, compresses, baths, and hot water bottles can help keep certain parts of your body warm. 

Turmeric and lemon water are both touted for their anti-inflammatory properties, although few studies have quantified just how much these ingredients actually impact RA symptoms. 

Alternative Medicine

Acupuncture is a popular form of alternative medicine that many patients use to cope with mild to moderate arthritis symptoms. The American College of Rheumatology has listed acupuncture as a “conditional recommendation” for osteoarthritis and RA. People may consider consulting their healthcare provider about including acupuncture in their normal treatment plan.

Researchers Pei-Chi Chou and Heng-Yi Chu say that arthritis is one of the most common conditions treated with acupuncture. They note that before 2010, around 41% of people with rheumatoid arthritis in Israel sought acupuncture.

Acupuncture may releases endorphins, which are hormones that can reduce inflammation—including the inflammation that may make your joints sore or stiff. 

Some practitioners may recommend that patients try cannabidiol (CBD ) oil to reduce tension in their bodies. In a 2019 medical study, researchers found that CBD helped promote more restful sleep, which can benefit RA patients who would otherwise wake up with pain or stiffness.

Talk to your healthcare provider or pharmacist before trying any new treatments. Like the home remedies listed above, these alternative medicines are meant to supplement, not replace, your current medications. 

Lifestyle Modifications

When you are in pain, the last thing you may want to do is to exercise. However, a medical study from the Journal of Aging Research found that physically fit RA patients report fewer and less severe symptoms than do patients who do not exercise regularly.

When maintaining a fitness routine, someone with rheumatoid arthritis may prioritize a low-impact activity to prevent further strain or pain. People with RA may consider the following: 

• Yoga 
• Walking 
• Hiking 
• Swimming 
• Weight training 
• Tai Chi 

Exercise is not a cure for RA, but the movement can keep your joints open and help increase your mobility over time. Always talk to your healthcare provider before starting an exercise regimen, as exercise is not usually recommended for people with actively inflamed joints.

When to See Your Healthcare Provider

Rheumatoid arthritis is a chronic condition, so it's likely that your RA may change over time. You may need to adapt your treatment plan if your symptoms become worse. There are several indicators that your current treatment might not be working as effectively as it should.

First, you might feel deeper or stronger pain. Second, your symptoms may prevent you from participating in your normal activities. You may not be able to walk, sleep, or move without bouts of stiffness or discomfort.

Third, you may notice new symptoms like nodules. Perhaps you feel pain in different locations or you wonder if your arthritis is spreading, such as if your pain or stiffness began in your hands but you now feel similar soreness in your knees or back. 

If you notice any of the above changes, you should consult your healthcare provider to determine the cause of your symptoms and to pursue treatments that may better fit your needs. 

A Word From Verywell

Rheumatoid arthritis may make you feel isolated, especially if your joint pain prevents you from leaving your home or doing your normal activities; however, it is a very common condition. While there is not yet a cure for this disease, millions of people survive and thrive with rheumatoid arthritis. Talk to your healthcare provider about how you can make a plan to cope with your RA pain.