About rheumatoid arthritis (ra)
What is rheumatoid arthritis (ra)?
Rheumatoid arthritis is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.
- Rheumatoid arthritis symptoms and signs include
- joint pain in the feet, hands, and knees,
- swollen joints,
- tender joints,
- loss of joint function,
- stiff joints,
- joint redness,
- rheumatoid nodules,
- joint warmth,
- joint deformity.
- Rheumatoid arthritis is a chronic disease characterized by periods of disease flares and remissions.
- In rheumatoid arthritis, multiple joints are usually, but not always, affected in a symmetrical pattern.
- Chronic inflammation of rheumatoid arthritis can cause permanent joint destruction and deformity.
- Damage to joints can occur early and does not always correlate with the severity of RA symptoms.
- The "rheumatoid factor" is an antibody that can be found in the blood of 80% of people with rheumatoid arthritis. Rheumatoid factor is detected in a simple blood test. Possible risk factors for developing rheumatoid arthritis include genetic background, smoking, silica inhalation, periodontal disease, and microbes in the bowels (gut bacteria).
- There is no cure for RA. The treatment of rheumatoid arthritis optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally surgery.
- Medications used in the treatment of rheumatoid arthritis include NSAIDs, DMARDs, TNF alpha inhibitors, IL-6 inhibitors, T-cell activation inhibitors, B-cell depletors, JAK inhibitors, immunosuppressants, and steroids.
- Early RA treatment results in a better prognosis.
- Rheumatoid arthritis can affect people of all ages. The cause of rheumatoid arthritis is not known.
Picture of hands affected by rheumatoid arthritis. Notice the joint deformity in the fingers; Image provided by Getty Images
What is rheumatoid arthritis (RA)?
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system contains a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies and immune cells in their blood that target their own body tissues, where they can be associated with inflammation. While inflammation of the tissue around the joints and inflammatory arthritis are characteristic features of rheumatoid arthritis, the disease can also cause inflammation and injury in other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. Rheumatoid arthritis that begins in people under 16 years of age is referred to as juvenile idiopathic arthritis (formerly juvenile rheumatoid arthritis).
While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. However, rheumatoid arthritis is typically a progressive illness that has the potential to cause significant joint destruction and functional disability.
A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments, and muscles.
In some people with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.
Rheumatoid arthritis is a common rheumatic disease, affecting approximately 1.3 million people in the United States, according to current census data. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age and even affects children (juvenile idiopathic arthritis), but it most often starts after 40 years of age and before 60 years of age. Though uncommon, in some families, multiple members can be affected, suggesting a genetic basis for the disorder.
What are the symptoms for rheumatoid arthritis (ra)?
Early rheumatoid arthritis tends to affect your 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:
- Salivary glands
- Nerve tissue
- Bone marrow
- Blood vessels
Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and Pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.
What are the causes for rheumatoid arthritis (ra)?
Rheumatoid arthritis is an autoimmune disease. Normally, your immune system helps protect your body from infection and disease. In rheumatoid arthritis, your immune system attacks healthy tissue in your joints. It can also cause medical problems with your heart, lungs, nerves, eyes and skin.
Doctors don't know what starts this process, although a genetic component appears likely. While your genes don't actually cause rheumatoid arthritis, they can make you more likely to react to environmental factors — such as infection with certain viruses and bacteria — that may trigger the disease.
What are the treatments for rheumatoid arthritis (ra)?
There is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (DMARDs).
Your doctor may refer you to a physical or occupational therapist who can teach you 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. For example, you may want to pick up an object using your forearms.
Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a hand grip helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.
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.
Rheumatoid arthritis surgery may involve one or more of the following procedures:
- Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can help reduce pain and improve the joint's flexibility.
- Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
- Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.
- Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
Surgery carries a risk of bleeding, infection and pain. Discuss the benefits and risks with your doctor.
What are the risk factors for rheumatoid arthritis (ra)?
Factors that may increase your risk of rheumatoid arthritis include:
- Your 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.
Is there a cure/medications for rheumatoid arthritis (ra)?
The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis.
- NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems and kidney damage.
- Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve symptoms quickly, with the goal of gradually tapering off the medication.
- Conventional DMARDs. These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage and severe lung infections.
Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara) and tocilizumab (Actemra).
Biologic DMARDs are usually most effective when paired with a conventional DMARD, such as methotrexate. This type of drug also increases the risk of infections.
- Targeted synthetic DMARDs. Baricitinib (Olumiant), tofacitinib (Xeljanz) and upadacitinib (Rinvoq) may be used if conventional DMARDs and biologics haven't been effective. Higher doses of tofacitinib can increase the risk of blood clots in the lungs, serious heart-related events and cancer.