What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease that occurs because the immune system malfunctions and attacks healthy cells by mistake. RA mainly affects the synovial linings of joints but might also affect other tissues throughout the body, including the heart, lungs, and eyes. 

The article covers the signs and symptoms of RA, its causes, stages, treatment, and more. 

Rheumatoid Arthritis Symptoms

The earliest signs of rheumatoid arthritis are body aches, pain, and weakness. Symptoms of RA usually begin slowly, with mild symptoms that come and go. 

Symptoms will affect both sides of the body and include:

• Fatigue
• Malaise (a general unwell feeling)
• Pain and stiffness in more than one joint
• Morning joint stiffness 
• Tenderness and swelling of affected joints. 
• Weight loss and loss of appetite
• Fever 
• Numbness and tingling 
• Decreased joint range of motion (full movement potential of a joint)
  

What Does Arthritis Pain Feel Like?

The pain associated with RA varies from person to person. People with RA might also experience changes in pain throughout the day, including periods of flare-ups (worsening pain and symptoms).

RA causes inflammation of the joints, leading to pain, tenderness, and warmth around the affected joints. The pain can be deep and achy, or it can be dull or persistent.

Some people with RA may experience sharp or shooting pain when they move the affected joints. They might also feel stiffness, especially in the morning and after periods of inactivity. 

RA Flare-Ups

People with RA will have periods in which their disease flares up. These are times inflammation and disease activity are high. 

The most common symptoms people feel during flares are severe joint pain and swelling, stiffness, and fatigue. A flare-up can last a few days, or it can last for weeks or months. The worse the flare is, the harder it is for you to complete daily tasks.

Specific events sometimes trigger flare-ups. Triggers for RA include dietary changes, stress, illness or infection, weather changes, overexertion, missing medication doses, and smoking.

What Causes Rheumatoid Arthritis?

RA is an autoimmune disease, which means a malfunction occurs in the immune system that causes it to attack healthy tissues. Its exact cause is unknown, but researchers have identified specific genetic, environmental, lifestyle, and hormonal factors that might be linked to its development.

RA Risk Factors

RA is associated with risk factors that may operate alone or in combination. Such risk factors include:

• Genetics: A family history of RA increases your risk for the disease. But family history alone is not enough to trigger the disease, and getting RA without a family history is possible. 
• Environment: Certain aspects of your environment might increase your risk for RA. These include exposure to chemicals and pollutants, chronic stress, past physical or emotional trauma, an illness, or viral or bacterial infection.
• Lifestyle: Researchers believe that nongenetic risk factors can lead to the development of RA. This includes lifestyle factors like smoking, obesity, diet, and other poor health choices. 
• Hormones: Research shows RA affects people assigned female at birth more so than people assigned male at birth. Women are 3 times more likely to have RA. Because of this, researchers believe sex hormones contribute to the development of the disease. About 50% of women with RA develop it during their reproductive years. And RA disease activity and progression are far worse for women than men.

(Note that when research or health authorities are cited, the terms for sex and gender in the source are used.)

Types of Rheumatoid Arthritis

Because there are differences in RA symptoms and disease severity, researchers believe that RA falls into different subtypes, as follows:

• Seropositive RA: People with seropositive RA have rheumatoid factor and/or anti-cyclic citrullinated peptides (anti-CCPs) in their blood. These antibodies attack the body and cause RA symptoms.
• Seronegative RA: People with seronegative RA do not have antibodies associated with RA in their blood. Even without these antibodies, a diagnosis can still be made based on symptoms, family history, and imaging studies that show bone and cartilage changes unique to RA.
• Juvenile idiopathic arthritis (JIA): Sometimes called juvenile RA, JIA affects children 16 and older. It is the most common type of childhood arthritis. Certain types of JIA cause similar symptoms to adult RA and are treated with some of the same medicines. 
  

Osteoarthritis vs. Rheumatoid Arthritis

Osteoarthritis (OA) is the most common type of arthritis. Unlike RA, it is not an autoimmune disease. It occurs due to the breakdown of joint cartilage.

Causes of OA include aging, joint injuries, repetitive joint use, being overweight, and having a family history of OA. Inflammatory processes do not cause OA, so it does not affect other body areas, such as the eyes or heart. 

OA develops over many years and typically affects older adults. It does not cause whole-body symptoms like fatigue and fever. It can get progressively worse with age, but unlike RA, there are no disease-modifying treatments to prevent progression.

OA is classically asymmetric (affecting only one joint), but it can affect both sides of the body (both knees, both hips, etc), the way RA traditionally does.

How Is Rheumatoid Arthritis Diagnosed?

There is no single test to diagnose RA. A healthcare provider will make a diagnosis using different diagnostic methods.

A diagnosis of RA typically involves: 

• Medical history: This includes a review of symptoms, your overall health, and a family history.
• Physical examination: The healthcare provider will check your joints for swelling, warmth and redness. They will also check your range of motion of affected joints, reflexes, and muscle strength. 
• Lab work: Blood tests for RA include anti-CCP and rheumatoid factor. People with RA typically have elevated inflammatory markers (erythrocyte sedimentation rate and C-reactive protein). A complete blood count (CBC) may detect anemia (a low number of healthy red blood cells) and thrombocytosis (a high platelet count), A metabolic panel may show low albumin levels. These result from chronic inflammation.
• Imaging: The healthcare provider might request imaging, including X-rays, magnetic resonance imaging (MRI), and ultrasound, to determine how severe your RA is. They may also request imaging if blood work doesn’t help in making a diagnosis. 
  

Stages of Rheumatoid Arthritis

RA can be classified into stages. Each stage is unique in the symptoms it causes and how it affects a person’s quality of life.

The stages of RA are:

• Stage 1, or early stage: This stage produces joint symptoms and early symptoms like fatigue and fever, but joint damage is uncommon.
• Stage 2, or moderate stage: This stage causes inflammation of the synovium (lining of the joint) and early cartilage damage.
• Stage 3, or severe stage: At this stage, RA starts to damage bones and joints. Cartilage starts to wear away, leading to bone-on-bone pain. 
• Stage 4, or end stage: The joints no longer work at the end stage, and there is joint damage or deformity. Surgery is typically done to treat joint damage at this stage.
  

Rheumatoid Arthritis Treatment

Treating rheumatoid arthritis focuses on controlling inflammation and pain, stopping joint damage, and preventing disability. Treatment for RA includes medicines, therapies, lifestyle changes, and surgery to restore joint function if needed.

RA Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen), and steroids can be used for short-term control of pain and inflammation.

Traditional disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate, are first-line RA therapies. They can slow down disease progression and save your joints from permanent damage.

Biologic DMARDs are typically prescribed when traditional DMARDs don’t help. These drugs are potent and affect immune proteins called cytokines.

Janus kinase (JAK) inhibitors are the newest medicines for RA. These drugs tamp down your immune system to ease inflammation to prevent joint damage.

Therapies

Both physical and occupational therapy can help you to keep your joints strong and flexible. An occupational therapist might suggest ways to protect your joints while doing daily tasks. They can also recommend assistive devices that help avoid stress on your joints. 

Lifestyle Changes

Some lifestyle changes can reduce the effects of RA. These might include:

• Being active: Gentle exercise can help strengthen the muscles around the joints. Being active can also improve fatigue levels and help you sleep better at night. 
• Learn to cope: It is essential to find ways to cope by reducing stressors in your life. Yoga, meditation, and deep breathing are good ways to manage stress.
• Not smoking: Research has found smoking can lead to more severe RA, and people who smoke are less likely to experience remission (inactive disease). It might also decrease the effectiveness of RA medicines and increase your risk for disease complications. 
  

Surgery

If you experience RA joint damage, your healthcare provider might recommend surgery to repair or replace damaged joints. Surgery can reduce pain and improve joint function.

Rheumatoid Arthritis Diet

No specific diet is recommended for RA. The best-studied diet in autoimmune disease is the Mediterranean diet, which emphasizes vegetables, fruits, legumes, whole grains, fish, and olive oil. These seem to have anti-inflammatory effects.

There may be a connection between an anti-inflammatory diet and improved RA symptoms. You can add anti-inflammatory foods to your diet and avoid pro-inflammatory foods.

Foods that might help to reduce inflammation include:

• Fruits and vegetables 
• High-fiber foods
• Whole grains
• Lean meats 
• Nuts and seeds
• Fatty fish 
• Olive oil 
  

Foods to avoid include:

• Sugar and high fructose corn syrup 
• Fried foods
• Refined carbs (processed foods that contain added sugar or flour)
• Processed and red meats 
• Alcohol 
• Gluten 
• Sodium 

Complications of Rheumatoid Arthritis 

A strong misconception about RA is that it only affects the joints. But the same inflammatory processes that affect the joints also cause problems in the eyes, skin, heart, blood vessels, and other organs. Also, the medications you take to treat the condition can cause serious side effects. 

Some complications of RA are:

• Blood diseases, including anemia (a low number of healthy red blood cells), Felty syndrome (includes a low white blood cell count and an enlarged spleen), and rheumatoid vasculitis (blood vessel inflammation).
• Diabetes
• Eye conditions, including scleritis (inflammation of the white part of the eye)
• Heart and blood vessel diseases, including high blood pressure, myocarditis (inflammation of the heart muscle), and pericarditis (inflammation in the sac surrounding the heart).
• Life-threatening infections
• Lung problems, which include lung nodules, pleuritis (inflammation of the lining of the chest cavity), and intestinal lung disease (inflammation the supportive tissues in the lungs)
• Mood disorders, including depression
• Osteoporosis (bone weakening)
• Skin symptoms, such as rheumatoid nodules (lumps of tissue below the skin) and ulcer-like spotting on the skin from vasculitis 
  

Living With Rheumatoid Arthritis

There is no cure for RA, but the condition is treatable. Thanks to treatment advances, most people with RA can enjoy a good quality of life. Make sure you keep follow-up visits with a rheumatologist (a specialist in conditions of the joints, muscles, and fibrous tissue) and follow your treatment plan.

To best manage RA, consider implementing some lifestyle changes, including getting regular exercise, watching your weight, eating healthy, sleeping better, managing stress, and avoiding smoking. If you have difficulty coping with the effects of the disease, reach out to loved ones for support or seek counseling.