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Rheumatoid arthritis

Rheumatoid arthritis
Rheumatoid arthritis

Definition

Rheumatoid arthritis (RA) is a long-term disease. It leads to inflammation of the joints and surrounding tissues. It can also affect other organs.

Alternative Names

RA; Arthritis - rheumatoid

Causes

The cause of RA is unknown. It is an autoimmune disease. This means the body's immune system mistakenly attacks healthy tissue.

RA can occur at any age, but is more common in middle age. Women get RA more often than men.

Infection, genes, and hormone changes may be linked to the disease. Smoking may also be linked to RA.

It is less common than osteoarthritis, which is a condition that occurs in many people due to wear and tear on the joints as they age.

Symptoms

Most of the time, RA affects joints on both sides of the body equally. Fingers, wrists, knees, feet, elbows, ankles, hips and shoulders are the most commonly affected.

The disease often begins slowly. Early symptoms may include:

Joint symptoms may include:

Other symptoms include:

Exams and Tests

There is no test that can determine for sure whether you have RA. Most people with RA will have some abnormal test results. However, some people will have normal results for all tests.

Two lab tests that are positive in most people and often help in the diagnosis are:

Other tests that may be done include:

Treatment

RA most often requires long-term treatment. Treatment may include;

Early, aggressive treatment for RA with newer drug categories can be very helpful to slow joint destruction and prevent deformities.

MEDICINES

Disease modifying antirheumatic drugs (DMARDs): These are the drugs that are tried first in people with RA. They are prescribed along with rest, strengthening exercise, and anti-inflammatory drugs.

Anti-inflammatory medicines: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

Antimalarial medicines: This group of medicines includes hydroxychloroquine (Plaquenil). They are most often used along with methotrexate. It may be weeks or months before you see any benefit from these drugs.

Corticosteroids: These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects. Therefore, they should be taken only for a short time and in low doses when possible.

Biologic agents: These drugs are designed to affect parts of the immune system that play a role in the disease process of RA.

They may be given when other medicines for RA have not worked. Sometimes, biologic drugs are started sooner, along with other RA drugs. However, because they are very expensive, insurance approval is generally required.

Most of them are given either under the skin or into a vein. There are several types of biologic agents.

Biologic agents can be very helpful in treating RA. However, people taking these drugs must be watched very closely because of serious risk factors, including:

SURGERY

Surgery may be needed to correct severely damaged joints. Surgery may include:

PHYSICAL THERAPY

Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong.

Sometimes, therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement.

Other therapies that may help ease joint pain include:

NUTRITION

Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eat foods rich in fish oils (omega-3 fatty acids). Smoking cigarettes should be stopped. Excessive alcohol should also be avoided.

Support Groups

Some people may benefit from taking part in an arthritis support group.

Outlook (Prognosis)

How well a person does depends on the severity of symptoms and the response to treatment. It is very important to have regular return visits to your health care provider, who will adjust treatment to control the arthritis.

Permanent joint damage may occur without proper treatment. Early treatment with a three-drug DMARD combination known as "triple therapy," or with the biologic drugs, can decrease joint pain and damage. This will help in improving the prognosis of this disease. It is possible to have remission of RA without needing other medicines if it is treated early with these drugs. These drugs are given by specialists called rheumatologists.

Possible Complications

If not well treated, RA can affect nearly every part of the body. Complications may include:

However, these complications can be avoided with proper treatment. The treatments for RA can also cause serious side effects. Talk to your provider about the possible side effects of treatment and what to do if they occur.

When to Contact a Medical Professional

Call your provider if you think you have symptoms of RA.

Prevention

There is no known prevention. Smoking cigarettes, along with long-term (chronic) gum infections, appears to worsen RA, so it is important to avoid tobacco and maintain healthy teeth and gums. Proper early treatment can help prevent further joint damage.

References

Erickson AR, Cannella AC, Mikuls TR. Clinical features of rheumatoid arthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 70.

Garneau E. Rheumatoid arthritis. In: Ferri FF, ed. Ferri's Clinical Advisor 2018. Philadelphia, PA: Elsevier; 2017:1125-1128.

June RR, Moreland LW. Rheumatoid arthritis. In: Benjamin IJ, Griggs RC, Wing EJ, Fitz JG, eds. Andreoli and Carpenter's Cecil Essentials of Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 77.

Mason JC. Rheumatic diseases and the cardiovascular system. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 84.

Muller D. Rheumatoid arthritis. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 49.

O'Dell JR. Rheumatoid arthritis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 264.

Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68(1):1-26. PMID: 26545940 www.ncbi.nlm.nih.gov/pubmed/26545940.


Review Date: 7/14/2017
Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.