From symptoms to diagnosis to treatments, here’s what you need to know about the progression of RA.
Rheumatoid arthritis (RA) is a chronic disease that affects the joints. More than 1.3 million Americans have been diagnosed with RA. Of these individuals, more than 75 percent are women. It can occur at any age, but it’s most often diagnosed between the ages of 30 to 59.
RA is an autoimmune disorder, which it isn’t the same as some types of arthritis like osteoarthritis (OA). With RA, the body’s own immune system mistakenly attacks the tissue lining the joints (called synovium). This causes pain, stiffness, and swelling due to inflammation. Over time, the affected joints become increasingly dysfunctional.
If left untreated, RA can result in permanent joint damage. It can impact any joint, but the fingers, hands, and feet are most often affected.
Fortunately, modern drug treatments have greatly improved the chances that a person with RA will be able to lead a healthy and relatively normal life and prevent progressive damage.
The symptoms of RA vary from person to person. Most people will experience swelling, pain, and stiffness in multiple joints, which will be similar on both sides of the body (symmetric). RA symptoms are usually worse in the morning, and stiffness may persist for hours after waking. As an autoimmune disease, RA symptoms may be marked by periods of flares followed by periods of remission or disease inactivity.
- persistent, early morning joint pain or stiffness
- muscle pain (myalgia)
- flu-like symptoms (including low-grade fever)
- lumps under the skin (rheumatoid nodules)
- dry eyes or mouth
Because RA can progress rapidly, early diagnosis and treatment are important. Your doctor will review your symptoms and medical history, as well as perform a physical examination. It may take time to diagnose RA in its early stages as many of its symptoms mimic other conditions.
While there’s no single test for RA, your doctor and rheumatologist may perform one or multiple diagnostic tests.
As a progressive disease, RA is classified based on its stages or severity of symptoms and disability. Knowing the stage of your disease, as well as how fast the condition is progressing, can help your doctor determine the best treatment plan. Fortunately, due to modern medical advances, a person with RA is unlikely to reach stage IV if treatment is started early.
- Stage I (Early):
- some joint swelling or pain during movement
- some evidence of osteoporosis (around joints) based on X-ray scans
- no destructive changes to joints
- no physical limitations
- some joint discomfort during movement
- osteoporosis and slight bone or joint damage
- adjacent muscles may show signs of atrophy
- nodules or tenosynovitis may be present
- no joint deformities
- limited mobility
- joint pain, extended morning stiffness, and weakness
- osteoporosis and loss of cartilage and erosion of bones
- muscle atrophy is extensive
- nodules and tenosynovitis present
- joint deformities present
- unable to perform normal activities, including self-care or occupational activities
- jo includes everything in stage III
- fibrous or boney ankylosis present (joints fuse)
- mostly or completely unable to perform normal activities
- may be bed-ridden
Since their introduction a little more than a decade ago, biologic drugs have quickly become an effective type of RA treatment.
Because they provide rapid symptomatic relief, steroids are sometimes also considered first-line therapies. Older disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, can take up to four weeks to work. Biologics, on the other hand, tend to decrease inflammation more rapidly. In most cases, a biologic will be added to methotrexate if this medication alone doesn’t provide relief. However, biologics may also be used on their own.
What Are All the Treatment Options for RA?
RA affects everyone differently, so treatment will also vary from person to person. Starting treatment early can help ensure a better quality of life.
Disease-modifying antirheumatic drugs (DMARDs) are available by prescription only. Unlike other drugs that treat just the symptoms of RA, DMARDs may slow the progression of the disease. They may also relieve pain and inflammation, but it can take several weeks or even months to take effect. DMARDs include:
Biologics are the newest class of drugs for the treatment of moderate to severe RA. They work by selectively targeting certain components of the immune system directly involved in the RA inflammatory process. Similar to DMARDs, biologics can slow or even halt progression of the disease, especially when treatment begins relatively early. They may be prescribed alone, or in combination with another DMARD. While biologics have their own set of potential side effects, they tend to be better tolerated and may take effect more rapidly than other drugs. Biologics include:
- etanercept (Enbrel)
- infliximab (Remicade)
- adalimumab (Humira)
- anakinra (Kineret)
- abatacept (Orencia)
- rituximab (Rituxan)
- certolizumab pegol (Cimzia)
- golimumab (Simponi)
- tocilizumab (Actemra)
Nonsteroidal anti-inflammatory (NSAID) drugs
This class of drugs includes over-the-counter medications and prescription COX-2 inhibitor drugs. NSAIDs provide symptomatic relief from pain and inflammation, but they don’t alter the progression of the disease. They may also pose some risk for heart and stroke issues.
- ibuprofen (Advil, Motrin IB, Nuprin)
- naproxen sodium (Aleve)
The most common prescription NSAIDs:
- celecoxib (Celebrex)
- ibuprofen (prescription-strength)
- nabumetone (Relafen)
- naproxen sodium (prescription-strength)
- naproxen (Naprosyn)
- piroxicam (Feldene)
- meloxicam (Mobic)
Also known as steroids, corticosteroids are prescription drugs that work to reduce pain and inflammation. These drugs suppress the immune system in a general fashion, so the risk of infection may be greater when taking them.
Potential side effects include:
- increased blood sugar
- stomach ulcers
- high blood pressure
- and others
- prednisone (Deltasone, Sterapred, Liquid pred)
- dexamethasone (Dexpak, Taperpak, Decadron, Hexadrol)
- hydrocortisone (Cortef, A-Hydrocort, Hydrocortone, and others)
- methylprednisolone (Methacort, Depopred, Predacorten, and others)
In addition to medications, certain lifestyle factors can also be beneficial in managing your RA. These factors include your diet, activity level, and other life choices.
There’s some evidence that eating a diet rich in natural antioxidants may help manage symptoms. This means eating a well-balanced diet centered on plant-based foods. Eating more fiber, and increasing your intake of fruits, vegetables, whole grains, and extra virgin olive oil, may also help reduce inflammation. Omega-3 fatty acids from cold-water fish may also help relieve inflammation. These types of fish include:
Research also shows that exercising may also help RA symptoms. Water aerobics, walking, biking, and practicing yoga may be good options. As far as other life choices, reducing your stress level and getting an adequate amount of vitamin D can be helpful as well. Quitting smoking, which is a major risk factor for RA, is another helpful recommendation.
In the past, RA treatment consisted largely of providing symptomatic relief. But the introduction of DMARDs and biologics has transformed the management of RA. Someone diagnosed with RA today is likely to have a near-normal life through careful monitoring and targeted treatments.
Studies have found that early treatment may “improve long-term outcomes” and that active and aggressive treatment “pays off, even in the long run”. Experts suspect that early treatment with inflammation-reducing therapies may also reduce the incidence of cardiovascular disease among RA patients. Research also shows that switching drugs may be helpful to those who don’t respond to an initial therapy.
But while early treatment can slow disease progression, some treatments may also trigger unwanted infections. For example, because biologics work by targeting specific aspects of the immune system, there’s the potential risk of developing opportunistic infections such as tuberculosis and certain fungal infections.
Despite this risk, biologics are still considered to be extremely beneficial to those with RA. Modern biologics have been shown to prevent joint damage and the associated surgeries and have greatly improved patients’ ability to lead near-normal, productive lives.