What sets rheumatoid arthritis apart from other forms of arthritis?
More than 50 million Americans have some form of arthritis. It’s estimated that 1.3 million people have rheumatoid arthritis (RA) in particular. RA typically develops between the ages of 30 and 60, and women are more likely to be diagnosed with this chronic inflammatory disease.
RA is an autoimmune disorder. It produces an inflammatory reaction within the body, triggering healthy cells to attack joints and surrounding tissues. This can cause pain and swelling in the hands, feet, knees, and hips.
There isn’t a cure for RA, but there are many treatment options to help manage your symptoms and preserve quality of life. Your treatment plan will depend on the severity of your condition and how far it has progressed.
Without treatment, RA can cause permanent joint damage.
Keep reading to learn how mild, moderate, and severe RA differ in symptoms and treatment.
There isn’t one single diagnostic tool used to detect RA.
Your doctor might make a diagnosis based on the following information:
- personal or family history of related autoimmune diseases, such as lupus or psoriatic arthritis
- a positive rheumatoid factor blood test
- elevated levels of C-reactive proteins in the blood
- X-rays to pinpoint areas of joint damage and possible bone spurs
RA looks different at each stage. After a diagnosis is made, your doctor will develop a treatment plan to help manage symptoms and slow disease progression.
Mild RA is the least severe form of this condition. At this stage, you may experience:
- joint pain and swelling that comes and goes
- joint stiffness from time to time, especially in the morning
- low-grade fever of about 99°F (37.2°C)
RA can be hard to detect at this stage because symptoms are so mild. People often write these symptoms off as related to age or injury, and they don’t seek medical attention. If left untreated, RA can progress, so it’s important to see your doctor if you’re experiencing any unusual symptoms.
For RA, the Arthritis Foundation recommends “early, aggressive treatment.” The key is to stop the inflammation caused by RA. Not only will this reduce any pain and joint stiffness, but it can also stop disease progression.
Once RA is diagnosed, your doctor may prescribe:
- disease-modifying antirheumatic drugs (DMARDs)
For pain, your doctor may recommend an over-the-counter (OTC) nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil) or naproxen (Aleve).
While you are still in the mild stage, certain lifestyle changes can help improve your condition and delay progression.
- Eat right and quit smoking: A healthy lifestyle goes a long way in stalling arthritis. Adopt a healthy diet that includes plenty of fruits and vegetables. This will help improve your overall well-being and control your weight.
- Exercise: Aim for routines that can help build muscle around the joints but don’t cause damage. Walking, swimming, and other low-impact workouts are best. Avoid high-impact repetitive exercises, such as running, jumping, or any sports that involve kicking. Warm up before exercise to lubricate joints, and stretch at the end of your workout to avoid injury.
- Use hot and cold treatments: Ask your doctor about using heating pads and ice packs as part of your regular self-care plan. Some people find applying ice helps reduce swelling, whereas applying heat helps relieve pain.
Moderate RA has many of the same characteristics as mild RA. You may find that your joint pain and stiffness have become more frequent. You may even “see” inflammation in certain joints, such as redness in your hands or knees.
The key difference is that, at this stage, these symptoms will affect your ability to perform everyday tasks. You may find it difficult to reach for things on the top shelf or have a hard time gripping smaller items in your hand.
You may also experience:
- skin rashes
- night sweats
- mild fever of about 101°F (38°C)
- unexplained weight loss
With moderate RA, the goal is to control pain and inflammation while improving mobility. The medications for moderate RA are the same as for mild RA.
If you were previously diagnosed with mild RA, your doctor may add to your treatment plan. For example, if you were previously taking a DMARD, they may also recommend an injected biologic medication.
If you’re initially diagnosed with moderate RA, your doctor will prescribe one or more of the following:
If your symptoms are disrupting your sleep, you may also consider adding a sleep medication to your regimen. This can help you achieve better rest and relaxation.
Some popular OTC options include:
- diphenhydramine (Benadryl)
- doxylamine succinate (Unisom SleepTabs)
- valerian root
Be sure to check with your doctor before taking any new OTC medications. They should confirm that your prescribed medications won’t interact with any OTC option that you’re considering.
With severe RA, joint pain and inflammation can be overwhelming at times. By this stage, most of your joints are experiencing swelling and pain. You may have deformities, like malalignment, in some joints as a result of cartilage destruction.
Unlike mild to moderate forms of RA, severe stages can be completely debilitating. Severe joint damage can cause noticeable mobility issues, and your pain and discomfort may be at an all-time high.
It’s estimated that 60 percent of people dealing with severe RA are unable to work within 10 years of disease onset.
Treating severe RA
In addition to the standard RA medications, your doctor may recommend physical and occupational therapies to improve mobility. This helps you complete everyday tasks and maintain your independence.
Joint replacement surgery may be recommended as a last resort.
If left untreated, RA may lead to decreased mobility and joint deformity.
RA can also increase your risk for:
- dry eyes and mouth
- carpal tunnel syndrome
- osteoporosis, a condition that weakens your bones
- rheumatoid nodules, firm bumps of tissue found around pressure points
- heart problems, such as hardened or blocked arteries
- lung disease resulting from inflammation or scarring in the lungs
- lymphoma, which is a group of blood cancers that develops in the lymph system
If you’re experiencing symptoms of RA, it’s important to see your doctor as soon as possible. Early diagnosis can help you get a handle on your symptoms and delay disease progression.
If at any point you notice a change in your systems, see your doctor. They may need to adjust your treatment plan.
During the early stages, symptoms can be managed at home by keeping active, eating healthy, and engaging in social activities that help keep your mood positive. Isolating yourself from social interaction will only increase your risk for developing RA-related depression later on.
As your symptoms progress, medication and physical therapy can help you maintain a healthy level of mobility. Staying active is key, as this can help you manage your condition and boost your overall well-being. Going for a walk, visiting a neighbor, or even hitting the gym for some low-impact exercise are all good options.
The key to treating RA and preventing complications is to see your doctor at the first sign of joint pain and inflammation. If you’ve already been diagnosed with RA and your symptoms have gotten worse, you should make a follow-up appointment right away. Your doctor can tweak your treatment plan as needed and provide personalized guidance.
How does RA affect your bone density? Does this change as the condition progresses?
Patients with RA have an increased risk of bone loss or osteopenia (decrease bone density) for a number of reasons. Often, corticosteroids are used to decrease inflammation, ease pain, and increase mobility. These glucocorticoids contribute to bone loss. Patients with RA tend to protect their joints by limiting motion. Inactivity can increase bone loss whether there is disease or not. Finally, the inflammation of the synovial tissue in the joints itself can cause loss of density of the adjacent bone. If untreated, persistent inflammation or progression of the disease will contribute to worsening of the osteopenia.Brenda B. Spriggs, MD, MPH, FACPAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.