Rheumatoid arthritis is an autoimmune condition that can cause pain, swelling, and stiffness in the joints. Though there is no cure, early diagnosis and treatment can help manage symptoms and prevent permanent joint damage.
Rheumatoid arthritis (RA) is an autoimmune disease that can cause joint pain, inflammation, and damage throughout your body.
The joint damage that RA causes usually happens on both sides of the body.
So, if a joint is affected in one of your arms or legs, the same joint in the other arm or leg will probably be affected, too. This is one way that doctors distinguish RA from other forms of arthritis, such as osteoarthritis (OA).
Treatments work best when RA is diagnosed early, so it’s important to learn the signs. Read on to learn everything you want to know about RA, from types and symptoms to home remedies, diets, and other treatments.
RA is a chronic disease marked by symptoms of inflammation and pain in the joints. These symptoms and signs increase during periods known as flares or exacerbations. Other times are known as periods of remission — this is when symptoms can disappear completely.
RA symptoms commonly affect joints in the hands, wrists, and knees, but can also affect tissues and organs throughout the body including the lungs, heart, and eyes.
Symptoms can include:
- pain or aching in more than one joint
- stiffness in more than one joint
- tenderness and swelling in more than one joint
- the same joint symptoms on both sides of the body
- loss of joint function and deformities
- low-grade fever
- loss of appetite
Symptoms can vary from mild to severe. It’s important not to ignore your symptoms, even if they come and go. Knowing the early signs of RA will help you and your healthcare provider better treat and manage it.
There are a number of genetic and environmental factors that may increase your risk of developing rheumatoid arthritis.
If you have RA, your immune system sends antibodies to the lining of your joints as part of the disease process. These antibodies attack the tissues lining your joints, causing the lining cells (synovial cells) to divide and contribute to inflammation. During this process, chemicals are released that can damage nearby bones, cartilage, tendons, and ligaments.
If RA is not treated, the joint will become damaged and lose its shape and alignment, eventually becoming destroyed.
- Age. The onset of RA is
highestamong adults in their 50s. Risk continues to increase with age for people assigned male at birth. RA often occurs in people assigned female at birth during their child-bearing years.
- Sex. People assigned female at birth are two to three times more likely to develop RA than people assigned male at birth.
- Genetics. People born with certain genes, called HLA class II genotypes, are more likely to develop RA. The risk of RA may be highest when people with these genes have obesity or are exposed to environmental factors like smoking.
- History of live births. People with ovaries who have
never given birthmay be at a greater risk of developing RA than those who have given birth.
- Early life exposure. According to the
Centers for Disease Control and Prevention, children whose mothers smoked have double the risk of developing RA as adults.
- Smoking. Studies show that people who smoke cigarettes are at an increased risk of developing RA.
- Obesity. Having obesity can increase the risk of developing RA.
- Diet. High consumption of sodium, sugar (especially fructose), red meat, and iron is associated with an increased risk of developing RA.
Diagnosing RA can take time and may require multiple lab tests to confirm clinical examination findings. Your healthcare provider will use several tools to diagnose RA.
First, they’ll ask about your symptoms and medical history. They’ll also perform a physical exam of your joints. This will include:
- looking for swelling and redness
- examining joint function and range of motion
- touching the affected joints to check for warmth and tenderness
- examining for skin nodules
- testing your reflexes and muscle strength
If they suspect RA, they’ll most likely refer you to a specialist called a rheumatologist.
Since no single test can confirm a diagnosis of RA, your healthcare provider or rheumatologist may use several different types of tests.
They may test your blood for certain substances like antibodies, or check the level of certain substances like
Tests not only show if joint damage has occurred but also how severe the damage is.
A complete evaluation and monitoring of other organ systems might be recommended for some people with RA, too.
There are several types of blood tests that help your healthcare provider or rheumatologist determine whether you have RA. These tests include:
- Rheumatoid factor test. The RF blood test checks for a protein called rheumatoid factor. High levels of rheumatoid factor are associated with autoimmune diseases, especially RA.
- Anticitrullinated peptide antibody test (anti-CCP). This test looks for an antibody that’s associated with RA. People who have this antibody usually have the disease. However, not everyone with RA tests positive for this antibody. The anti-CCP test is more specific for RA than the RF blood test, and often is positive before the RF test.
- Antinuclear antibody test. The antinuclear antibody panel (ANA) tests your immune system to see if it’s producing antibodies to the nucleus of cells. Your body often makes ANA antibodies as a response to many different types of autoimmune conditions, including RA.
- Erythrocyte sedimentation rate. The ESR test helps determine the degree of inflammation in your body. The result tells your doctor whether inflammation is present. However, it doesn’t indicate the cause or site of the inflammation.
- C-reactive protein test. A severe infection or significant inflammation anywhere in your body can trigger your liver to make C-reactive protein. High levels of this inflammatory marker are associated with RA.
There’s no cure for RA, but there are effective treatments that can help you manage it and prevent damage.
Rheumatoid arthritis (RA) can require both patients and doctors to adjust as they figure out the best ways to treat the symptoms and slow the progression of the condition.
Recently, advances in treatment strategies have resulted in ever-improving outcomes and quality of life for those with rheumatoid arthritis. Treat to Target is a treatment philosophy that rheumatologists use to effectively manage this disease.
The treat-to-target approach has resulted in fewer symptoms and higher remission rates for those with RA. The treatment strategy involves:
- setting a specific testing goal that signals either remission or low disease state
- testing acute phase reactants and performing monthly monitoring to assess progress of treatment and management plan
- switching medication regimen promptly if progress isn’t made
Treatments for RA help to manage the pain and control the inflammatory response. In many cases, this can result in remission. Decreasing the inflammation can also help to prevent further joint and organ damage.
Treatments may include:
Your healthcare provider will work with you to determine the best treatment plan for your medical needs.
For many people, these treatments help them live an active life and reduce the risk of long-term complications.
There are many types of medication for RA. Some of these medications help to reduce the pain and inflammation of RA. Others help to reduce flares and limit the damage that RA does to your joints.
The following over-the-counter medications help reduce the pain and inflammation during RA flares:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- acetaminophen (reduces pain but not inflammation)
The following drugs work to slow the damage that RA can cause to your body:
- Disease-modifying antirheumatic drugs (DMARDs). DMARDs work by blocking your body’s immune system response. This helps to slow down the progression of RA.
- Biologics. These new generation biologic DMARDs provide a targeted response to inflammation rather than blocking your body’s entire immune system response. They are an effective treatment for people who don’t respond well enough to more traditional DMARDs.
- Janus kinase (JAK) inhibitors. These are a newer subcategory of DMARDs that block certain immune responses. JAK inhibitors are drugs that your healthcare provider may use to help prevent inflammation and stop damage to your joints when DMARDs and biologic DMARDs don’t work for you.
Certain home remedies and lifestyle adjustments may help to improve your quality of life when living with RA. This includes exercise, rest, and assistive devices.
Low-impact exercises can help to improve the range of motion in your joints and increase your mobility. Exercise can also strengthen muscles, which can help to relieve some of the pressure from your joints.
You may also want to try gentle yoga, which can help you regain strength and flexibility.
Get enough rest
Apply heat or cold
Ice packs or cold compresses can help to reduce inflammation and pain. They may also be effective against muscle spasms.
You can alternate cold with hot treatments such as warm showers and hot compresses. This may help to reduce stiffness.
Try assistive devices
Certain devices such as splints and braces can hold your joints in a resting position. This may help to reduce inflammation, but it’s important to take breaks from using them to prevent “frozen joints” (contractors).
Canes and crutches can help you maintain mobility, even during flares. You can also install household devices, such as grab bars and handrails in bathrooms and along staircases.
Your healthcare provider or dietitian may recommend an anti-inflammatory diet to help with your symptoms. This type of diet includes foods that have lots of omega-3 fatty acids.
Foods high in omega-3 fatty acids include:
- fatty fish like salmon, tuna, herring, and mackerel
- chia seeds
- flax seeds
- berries, such as blueberries, cranberries, goji berries, and strawberries
- dark chocolate
- kidney beans
Eating lots of fiber is also important. Choose whole grain foods, fresh vegetables, and fresh fruit. Strawberries may be particularly beneficial.
- soy products, such as tofu and miso
- green tea
What you don’t eat is just as important as what you do eat. Make sure to avoid trigger foods. These include processed carbohydrates and saturated or trans fats.
Avoiding trigger foods and choosing the right foods when following an anti-inflammatory diet may help you manage your RA.
There are several different types of RA. Knowing which type you have may help your healthcare provider choose the best type of treatment for you.
Types of RA include:
- Seropositive RA. If you have seropositive RA, you have a positive rheumatoid factor or anti-CCP blood test result. This means you have the antibodies that cause your immune system to attack joints.
- Seronegative RA. If you have a negative RF blood test result and a negative anti-CCP result, but you still have RA symptoms, you may have seronegative RA. You may eventually develop antibodies, changing your diagnosis to seropositive RA.
- Juvenile idiopathic arthritis (JIA). Juvenile idiopathic arthritis refers to RA in children ages 17 years old and younger. The condition was previously known as juvenile rheumatoid arthritis (JRA). The symptoms are the same as those of other types of RA, but they may also include eye inflammation and issues with physical development.
Symptoms of seropositive RA can include:
- morning stiffness lasting 30 minutes or longer
- swelling and pain in multiple joints
- swelling and pain in symmetrical joints
- rheumatoid nodules
- weight loss
RA isn’t always confined to the joints. Some people with seropositive RA can experience inflammation in the eyes, salivary glands, nerves, kidneys, lungs, heart, skin, and blood vessels.
Arthritis in the hands may start as a low-level burning sensation that you feel at the end of the day. Eventually, you may experience pain that isn’t necessarily from using your hands. This pain can get quite severe without treatment.
You may also feel:
If the cartilage in your joints wears away, you may notice some deformities in your hands. You may also have a grinding feeling in the joints of your hands, fingers, and large joints, if the cartilage deteriorates completely.
As the disease progresses, fluid-filled sacs or synovial cysts typically develop in the wrists, knees, elbows, ankles and around the small joints of the hands. These cysts aren’t without complications and tendon rupture can occur in some cases.
You may also develop knobby growths, called bone spurs, in the affected joints. Over time, bone spurs can make it harder for you to use your hands.
If you have RA in your hands, your healthcare provider will work with you on exercises that can help you retain movement and function.
Exercises, along with other types of treatment, can help reduce inflammation and delay progression of the disease.
RA may be most visible in your hands and feet, particularly as the disease progresses and especially if you don’t currently have a treatment plan.
Swelling of fingers, wrists, knees, ankles, and toes are common. Damage to ligaments and swelling in the feet can cause a person with RA to have trouble walking.
If you don’t get treatment for RA, you may develop severe deformities in your hands and feet. Deformities of the hands and fingers may cause a curved, claw-like appearance.
Your toes can also take on a claw-like look, sometimes bending upward and sometimes curling under the ball of the foot.
You may also notice ulcers, nodules, bunions, and calluses on your feet.
Lumps, called rheumatoid nodules, can appear anywhere on your body where joints are inflamed. These can range in size from very small to the size of a walnut or larger, and they can occur in clusters.
Like RA, people with osteoarthritis (OA) can experience painful and stiff joints that make moving around difficult.
People with OA may have joint swelling after extended activity, but OA doesn’t cause significant enough inflammatory reaction to result in redness of the affected joints.
Unlike RA, OA isn’t an autoimmune disease. It’s related to the natural wear and tear of the joints as you age, or it can develop as a result of trauma.
OA is most often seen in older adults. However, it can sometimes be seen in younger adults who overuse a particular joint — such as tennis players and other athletes — or those who’ve experienced a severe injury.
RA is an autoimmune disease. The joint damage from RA isn’t caused by normal wear and tear. It’s caused by your body attacking itself.
Rheumatoid arthritis isn’t considered a hereditary disease, but it does run in some families. This may be due to environmental causes, genetic causes, or a combination of both.
If you have family members who have or have had RA, talk to your healthcare provider, especially if you have any symptoms of persistent joint pain, swelling, and stiffness unrelated to overuse or trauma.
Having a family history of RA increases your risk of getting the disease, and early diagnosis can make a big difference in how effective treatment will be.
- Premature heart disease. People who have RA are almost twice as likely to develop heart disease as those without the condition. Those who have obesity and RA are at the
highest risk. Coronary artery disease is the number one cause of death for people who have RA.
- Carpal tunnel syndrome. Carpal tunnel syndrome is common in people who have RA. It causes aching, numbness, or tingling in the hands and fingers. It’s caused by compression of a nerve in the hand called the median nerve.
- Interstitial lung disease. Interstitial lung disease is the primary pulmonary manifestation of RA and can develop when your lungs become inflamed.
- Pulmonary fibrosis. Pulmonary fibrosis is a condition that causes lung scarring and stiffness and makes it difficult to breathe. Pleurisy is another painful lung condition that is a complication of RA due to inflammation of the lung lining (pleura).
- Chest pain. Inflammation of tissues around your heart can lead to pericarditis, a condition that causes chest pain.
- Eyes conditions. Inflammation in the eyes from RA can lead to uveitis and scleritis, which causes eye redness and pain. It can also lead to Sjögren’s syndrome, which causes dry eyes.
- Vasculitis. Inflammation of the blood vessels, known as vasculitis, can cause vessels to thicken, weaken, narrow, and scar. In serious cases, it can affect blood flow to your body’s organs and be life threatening.
- Joint damage. Permanent joint damage can happen if RA is not managed or treated early. Joints can become severely deformed, and nearby tendons, bones, and cartilage can become damaged. Surgery is sometimes needed to prevent loss of joint function.
- Cervical myelopathy. Having RA puts you at an increased risk of developing cervical myelopathy. This condition results from compression of the spinal cord in the neck. It leads to dislocation of joints at the top of the spinal cord and can seriously affect mobility, and lead to permanent spinal cord damage.
- Pneumonia. Pneumonia is the most frequently encountered infection in people with RA.
- Renal failure. Renal failure is the third most common cause of death in people with RA. People with RA are at an
increased riskof both chronic kidney disease (CKD) and glomerulonephritis.
- Gastrointestinal hemorrhage. GI hemorrhage is a condition where heavy bleeding occurs in the upper parts of the digestive tract. It’s the most common GI complication for people with RA and is associated with nonsteroidal anti-inflammatory drugs (NSAIDs).
- Pancytopenia. Pancytopenia is a condition that occurs when a person has too few red blood cells, white blood cells, and platelets. It causes three blood diseases: anemia, leukopenia, and thrombocytopenia. The severity of anemia is correlated with the severity of RA.
- Lymphoma. People with RA are at an increased risk of
developingboth Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL).
- Subcutaneous nodules. These are lesions located deep in the dermis and subcutis layers of the skin. They are found in 30 to 40 percent of patients with RA and are associated with more severe diseases.
RA is a chronic disease that doesn’t currently have a cure. That said, most people with RA don’t have constant symptoms. Instead, they have flare-ups followed by relatively symptom-free periods called remissions.
The course of the disease varies from person to person, and symptoms can range from mild to severe.
Though symptoms may stop for extended periods, joint problems caused by RA will usually get worse over time. That’s why early treatment is so important to help delay serious joint damage.
If you’re experiencing any symptoms or have concerns about RA, talk to your healthcare provider.