Rheumatoid Arthritis Inflammation: What to Expect

Rheumatoid arthritis (RA) is a type of inflammatory arthritis. It occurs when the immune system, which normally protects you, malfunctions and starts to attack your healthy cells. RA mainly attacks the synovium (the lining of the joints), but it can cause inflammation (painful swelling) in other body parts.

RA will mainly attack the joints, usually many joints at once. It is a type of symmetrical arthritis, meaning if a joint on one side of the body is affected, so is the corresponding joint on the other side. For example, RA inflammation will affect both hands or both knees.

The most-affected joints in RA are the hands, wrists, and knees, although any joint can be affected. RA also can cause inflammation in tissues throughout the body, including the eyes, heart, and lungs.

RA affects around 1% of the world's population. In the United States, about 1.3 million Americans live with the condition. It affects 2 to 3 times more women than men. New diagnoses are common in middle age, although anyone can get RA, including children.

This article will discuss RA and its inflammatory processes, along with symptoms of RA and treatment options.

Person feeling pain from inflammation in rheumatoid arthritis

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How Does RA Cause Inflammation?

Inflammation is how the body defends itself from bacteria, viruses, and other substances. It is vital to the healing process. Inflammation can be acute or chronic.

Acute inflammation occurs from an injury or short-term illness. For example, if you cut your finger, your immune system sends white blood cells to protect the affected area, which creates redness and swelling you can see.

The same process occurs if you are sick with the flu, in which you would experience a sore throat, inflamed lymph nodes, fever, or body aches as you are healing.

Chronic inflammation, a primary characteristic of RA, also occurs in response to unwanted substances in the body. However, a chronic inflammatory reaction will continue long after the body has rid itself of foreign substances.

In RA, the body begins to produce autoantibodies, which are immune system proteins that mistakenly target the body's own tissues. This can lead to the release of substances that promote inflammation.

With RA, inflammation has two effects. The tissues around the joints swell and inflammatory chemicals wear down bone and cartilage. If inflammation continues, it leads to disease progression (worsening of RA) and continues to cause bone and joint damage.

Ongoing inflammation generally occurs as frequent disease flare-ups—periods in which you experience additional or new symptoms such as inflammation, pain, and fatigue.

Inflammation can also lead to RA complications throughout the body, including the eyes, skin, heart, and lungs. A study found that people with RA who had high levels of C-reactive protein (CRP, which is a marker of inflammation) had double the risk for heart attack. The study also found that up to 80% of people with RA also have lung involvement.

RA inflammation is also linked to additional medical problems. For example, a study reported in 2016 found that up to 41% of people with RA developed a comorbid condition (other health conditions in addition to RA). The most common comorbid conditions linked to RA were high blood pressure, diabetes, heart attack, stroke, cancer, and hypothyroidism (low thyroid activity).

Where Does RA Cause Inflammation?

When joints are inflamed in RA, the joint lining also becomes inflamed. Unchecked inflammation causes the synovium to thicken and leads to pain, swelling, redness, and warmth.

As RA progresses, inflammatory cells in the synovium invade the surrounding cartilage and bone, resulting in permanent damage. Once there is damage, a person will experience severe and chronic pain, balance and mobility issues, and joint deformity.

RA inflammation can also affect the surrounding structures of the joints and bones, including the muscles, ligaments, and tendons. Damage to these tissues causes weakness and reduces their ability to support the joints. This type of damage leads to more pain and joint damage.

Severe RA inflammation might lead to joint fusion and bony ankylosis. Joint fusion means that bones start to fuse together at a joint. This limits mobility and range of motion (how far a joint can be moved or stretched).

With bony ankylosis, the joints start to fuse with bone tissue rather than connective fibrous tissues. When this occurs, the affected joint cannot be bent or flexed.

Fortunately, joint fusion and bony ankylosis are rare because of today's acvanced treatment options for RA. Early diagnosis and aggressive treatment reduce the chance of joint and bone damage and minimize disease progression.

Earliest Signs of Inflammation

The earliest signs of inflammation in RA start gradually, often before people notice joint pain and stiffness. Early signs of an inflammatory process in RA include severe fatigue, sleep troubles, muscle aches, and cramping, low-grade fevers, numbness and tingling in the hands, and weight loss.

Symptoms of RA Caused by Inflammation

RA is a type of inflammatory arthritis in which joint inflammation occurs because of an overactive immune system. Much like other types of inflammatory arthritis, it mainly causes joint pain and stiffness, which are the result of chronic inflammation. Joints might also feel warm, swollen, and tender.

Joint symptoms in RA may present with:

  • Pain and swelling in more than one joint on both sides of the body
  • Warmth and visible redness
  • Morning stiffness that lasts more than 30 minutes or stiffness after periods of inactivity

Inflammation in RA also causes systemic symptoms—symptoms that affect the whole body.

Systemic symptoms of RA include:

  • Low-grade fevers
  • Malaise (feeling unwell)
  • Severe fatigue
  • Dry eyes and mouth
  • Eye inflammation
  • Muscle pain and weakness
  • Loss of appetite and weight loss
  • Digestive troubles
  • Skin complications, including rheumatoid nodules (small, firm lumps under the skin)
  • Anemia—a lack of healthy red blood cells to carry enough oxygen to the body's cells and tissues
  • Vasculitis (blood vessel inflammation)
  • Nerve pain, numbness, tingling, and other nerve symptoms
  • Kidney, lung, or heart disease

Systemic symptoms of RA occur both early in the disease and as the disease worsens.

Treating RA Inflammation

There is no cure for RA, but remission is possible when treatment starts early with medications known as disease-modifying antirheumatic drugs (DMARDs). RA remission means your disease is well-controlled and you experience few or no symptoms.

RA inflammation can also be managed with both long-term and short-term medicinal therapies. These might include:

Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. NSAIDs like Advil (ibuprofen) and Aleve (naproxen) are available over the counter. Your healthcare provider can prescribe a more potent NSAID if necessary.

Corticosteroids are given as an injection or pill. They can help reduce inflammation, which can improve pain and slow down joint damage. Your healthcare provider will prescribe a corticosteroid to relieve your symptoms quickly and for a short period.

These drugs are known for causing severe side effects with long-term use, including weight gain, diabetes, infections, and the thinning of bones.

DMARDs can save your joints by blocking inflammation. Without these medicines, inflammation will slowly destroy joint tissues. Types include:

  • Conventional DMARDs like Rheumatrex (methotrexate), Plaquenil (hydroxychloroquine), Azulfidine (sulfasalazine), Arava (leflunomide), and Aralen (chloroquine) work by slowing down your overactive immune system, which puts a stop to damaging inflammation.
  • Biologic DMARDs, such as Humira (adalimumab), Cimzia (certolizumab pegol), Remicade (infliximab), and Cosentyx (secukinumab), target individual inflammatory proteins called cytokines.
  • Targeted DMARDs, also called Janus kinase (JAK) inhibitors, work by inhibiting the activity and responses of certain enzymes. Three JAK inhibitors—Olumiant (baricitinib), Xeljanz (tofacitinib), and Rinvoq (upadacitinib)—have all been approved by the Food and Drug Administration (FDA) for treating RA.

Black Box Warnings for JAK Inhibitors

The FDA has issued warnings about the use of JAK inhibitors. They warn about an increased risk for severe heart-related events, including heart attack, stroke, blood clots, and death. They link Xeljanz explicitly to these events and note that Olumiant and Rinvoq may carry the same risks as Xeljanz. There might also be an increased risk for some cancers from these drugs.

These warnings do not mean you can't treat RA with JAK inhibitors. Your healthcare provider will consider all the risks and benefits of these drugs when deciding whether they are suitable for you, especially if you have an increased risk for cancer or heart disease or if you smoke.

Additional Remedies

While you will need to keep up with your treatment plan, there are some natural remedies that might help keep RA inflammation down and reduce pain and stiffness, including:

  • Keep moving: You may not feel like it, but exercise is good for people with RA because it can help to reduce pain and swelling. Your healthcare provider or a physical therapist can advise you on how to exercise safely with RA. In general, low-impact exercise is safest for people with RA—walking, stretching, tai chi, yoga, water exercises, swimming, and cycling.
  • Heat and cold: Both heat and cold treatments can bring about relief from RA symptoms. Cold treatment can ease joint swelling and inflammation, while hot therapy relaxes muscles and promotes blood flow. You can alternate between hot and cold or use whichever treatment gives you the most relief. Limit treatments to 15 minutes at a time, and leave at least 30 minutes between treatments.
  • Topical therapies: Many different creams, gels, and patches ease RA pain. According to a 2021 report, topical remedies are safer than NSAIDs and are less toxic to the body. They also provide effective pain relief and controlled release of a drug.

What to Expect

When you live with a long-term condition like RA that causes chronic inflammation, your body's overactive inflammatory response can eventually damage joints, tissues, organs, and other healthy cells.

Over time, this could mean joint damage, internal scarring, tissue death, and more. RA is also linked to several other serious diseases, including cancer, heart disease, kidney and lung problems, and other life-threatening illnesses.

But long-term damage to your body and disease complications are preventable. Working with your healthcare provider is the most effective way to gain control of your RA and enjoy a good quality of life.

It might take some time to find the right treatment plan for you. Treatments take some time to work, so it is crucial to stick to a treatment plan once you start it. It might take weeks or months before you see improvement.

Treating RA is a lifetime commitment. Find a rheumatologist (a specialist in inflammatory conditions affecting the bones and muscles) you can trust. Don't get discouraged if a particular drug doesn't work or stops working. You have many options to choose from if one does work.

Summary

Rheumatoid arthritis is a chronic disease in which the immune system malfunctions and starts attacking healthy tissues. These attacks are targeted mainly at the lining of the joints causing severe and painful inflammation.

Left unchecked, this inflammation can cause irreversible damage to your joints. RA inflammation can also increase your risk for other serious conditions, including heart disease and life-threatening infections.

While there is no cure for RA, treatment can help to lower inflammation, manage symptoms, and prevent further damage. Make sure you work with a rheumatologist to find the best treatment plan for your unique situation.

A Word From Verywell

Continuing advancements in RA treatments mean the future can be bright for people with RA. Many people can live a healthy and active life despite RA. But RA is a lifelong condition, which means ongoing treatment and monitoring are necessary to limit its effects on your body.

Make sure you see your healthcare provider regularly. Follow up with any testing, including blood work and imaging, they might request. You might also consider physical therapy to keep your joints and their surrounding tissues strong and healthy.

Frequently Asked Questions

  • What triggers inflammation in rheumatoid arthritis?

    Flare-ups (periods of high symptom activity and inflammation) in rheumatoid arthritis sometimes follow triggering events. These might include physical or emotional stress, infection or illness, medication issues, sleep troubles, overexertion, or hormone fluctuations.

  • How can I reduce inflammation from rheumatoid arthritis?

    During flare-ups, your healthcare provider might prescribe a corticosteroid to relieve symptoms quickly. NSAIDs can also help to bring down inflammation and relieve pain. You should stay on top of your treatment plan, which includes medicines that are designed to keep inflammation down.

  • Does rheumatoid arthritis cause systemic inflammation?

    Rheumatoid arthritis primarily causes inflammation of the joints but can also cause a systemic inflammatory response. That response can lead to systemic symptoms, such as fever, fatigue, malaise, dry eyes, a dry mouth, etc.

  • Are inflammatory markers raised in rheumatoid arthritis?

    People with rheumatoid arthritis have elevated inflammatory blood markers. These include both erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP), which are indicators of an inflammatory response in the body.

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