Rheumatoid arthritis (often shortened to “RA“) is a disease in which the immune system attacks the body’s own tissues. The joints of the hands, wrists, ankles, knees, and feet are usually the most seriously affected, but the severity and pattern of the disease varies substantially from one person to another Common early symptoms of rheumatoid arthritis include pain, swelling, and stiffness of the joints. Later, symptoms may include joint deformity and loss of joint movement. The pain and swelling may disappear at times as if the disease has been cured (a period called remission), only to flare up again later.
Without early treatment, the damage that rheumatoid arthritis causes can become worse over time. The disease has the potential to damage the joint’s tissues and the bones. In rheumatoid arthritis, continuous inflammation in the spaces between the joint gradually damage the fibrous connective tissue that holds the skeleton together at the joints (cartilage), narrowing the joint space and eventually eroding bone. Under normal circumstances, inflammation is a product of the body’s immune system, which fights off invaders and infections, and heals injuries. Inflammation usually dies down once the body has gotten rid of the problem. But in rheumatoid arthritis, the body’s immune system continues to attack the joints, which leads to persistent inflammation, for reasons that are not yet understood. This process gradually ruins cartilage and erodes the bones.
Rheumatoid arthritis can strike people as early as age 30, but it most often occurs in people between the ages of 40 and 60. Prior to 60 years of age, it affects women three times as often as it does men. After age 60, there is an equal frequency of men and women.
There are several different types of rheumatoid arthritis. Your diagnosis will be based upon your symptoms and the results of tests and x-rays. The diagnosis of RA is a clinical one, supported by laboratory tests and x-rays. The various types of rheumatoid arthritis are differentiated by the symptoms they produce and the presence or absence of a certain protein in the bloodstream. This protein, known as an ‘autoantibody‘, is called the rheumatoid factor (RF), and is produced as a result of the body attacking its own immune system. The presence or the absence of RF does not indicate whether or not you actually have rheumatoid arthritis. It can, however, indicate what type of the disease you have.
About 80% of people with rheumatoid arthritis have a positive test for rheumatoid factor. This form of rheumatoid arthritis is called rheumatoid factorpositive (or seropositive) rheumatoid arthritis.
In contrast, some people with rheumatoid arthritis consistently have a negative test for rheumatoid factor. This form of rheumatoid arthritis is called rheumatoid factornegative (or seronegative) rheumatoid arthritis. It tends to be milder than the seropositive type.
Rheumatoid factor status can fluctuate in some people with rheumatoid arthritis.
A team of health care providers often manages rheumatoid arthritis. A rheumatologista doctor who specializes in musculoskeletal conditions most commonly treats rheumatoid arthritis. However, a primary care doctor plays an important role in monitoring the effectiveness of treatment, treating other medical conditions, and addressing the psychological and social effects of rheumatoid arthritis. Who you see will depends on the severity of your rheumatoid arthritis.
A physical therapist will help you to rehabilitate any loss of movement you may experience. An occupational therapist will help you to improve and recover your ability to perform tasks in your daily living and working environments. Your team of health care professionals may also include a surgeon and a psychiatrist or psychologist to help you with the emotional stress of the condition.
Most people with rheumatoid arthritis can still participate in family, occupational, and social activities. Aggressive treatment during the first few months after diagnosis will keep your condition under control. While there may be some days where your pain and discomfort may prevent you from participating in your regular activities, there is a good chance that you could enjoy long periods of disease control.
Rheumatoid arthritis is thought to result from a combination of genetic susceptibility and exposure to some trigger. The specific trigger for rheumatoid arthritis has not been identified at this time. Researchers are still looking for the factor that suddenly initiates rheumatoid arthritis in susceptible people. They suspect that some infectious agent, perhaps a bacterium or virus, triggers the inappropriate immune reaction.
If you have rheumatoid arthritis in your family, you may be more susceptible to the disease yourself.
Pain in the joints is the hallmark of early rheumatoid arthritis The inflammation of rheumatoid arthritis causes joint pain, swelling, warmth, redness, and stiffness. Movement typically worsens the joint pain. Because many joints of the body are affected, rheumatoid arthritis is often associated with a sensation of generalized stiffness, especially in the morning and after inactivity. The stiffness lasts longer than 30 minutes, which is one factor that makes it different from another common type of arthritis called osteoarthritis.
In contrast to some other types of arthritis, rheumatoid arthritis affects many joints throughout the body. The joints of the hands, wrists, ankles, knees, and feet are usually most severely affected. The disease usually affects the same joints on the right and left sides of the body (symmetrical).
Several other conditions share symptoms with rheumatoid arthritis. The symptoms of rheumatoid arthritis may overlap with the symptoms of another form of arthritis called gout, and other autoimmune diseases, such as lupus. Tests can usually reveal which condition you actually have.
Rheumatoid arthritis can lead to irreversible joint changes over time. Without early and aggressive treatment, inflammation of the joint can lead to damage of the protective cartilage cushions, erosion of bone, and weakening of the tissues that normally support the joints (muscles, tendons, and ligaments) over time. This damage leaves the joints more susceptible to injury, and often results in deformities of the hands and feet that are usually irreversible. The chronic inflammation in the hands may cause the fingers to assume an unnaturally bent or crooked appearance.
Rheumatoid arthritis can lead to inflammation in other parts of the body, and to other problems, such as rheumatoid nodules. These effects most commonly occur in people with high levels of rheumatoid factor.
Genetics and gender partly determine your risk of rheumatoid arthritis. If your mother, father, or sibling has the disease, or if you are a woman, your risk increases. Your total risk for rheumatoid arthritis probably depends on a complex interaction of many different factors. Only a few of these factors have been identified. Genetics play a role in your risk of rheumatoid arthritis. If any of your first-degree relatives (mother, father, and siblings) have rheumatoid factorpositive rheumatoid arthritis, your risk of developing the disease increases fourfold.
Gender also plays a role in a person’s risk for rheumatoid arthritis. Prior to age 60, rheumatoid arthritis affects almost three times as many women as men. After that age, men and women are affected at about the same rate. However, middle age is the most common time for it to develop. Only 30% of patients with RA develop it over the age of 60.
The symptoms of rheumatoid arthritis may be present for months before the disease is diagnosed. In 90% of people, rheumatoid arthritis has a gradual onset. You may feel very tired, notice a loss of appetite, feel generally weak, and have muscle and joint aches. The actual joint swelling, warmth, redness, and restricted movement may not become evident for months.
The diagnosis of rheumatoid arthritis begins with a thorough medical history and physical exam. The history addresses the nature, severity, and duration of your symptoms as well as your family history. Your doctor will thoroughly inspect the joints for swelling, redness, warmth, and restricted movement. Examination of the skin and testing of tendon reflexes and muscle strength can also reveal signs that suggest rheumatoid arthritis. A general physical exam can help detect or rule out other medical conditions with similar symptoms.
The diagnosis is based on the patient’s symptoms and the findings on the physical examination. Tests help to confirm suspected rheumatoid arthritis, but no single test establishes the diagnosis. When the results of a medical history and physical exam suggest rheumatoid arthritis, a variety of tests can help to confirm a diagnosis. Unfortunately, none of these tests alone provides proof-positive evidence that rheumatoid arthritis is present. For example, the rheumatoid factor test is positive in up to 80% of people with rheumatoid arthritis. However, some people with the disease have a negative test result, and some healthy people and people with other diseases have a positive test result.
Prevention and Screening
There is currently no way to prevent rheumatoid arthritis. Because the cause of rheumatoid arthritis is unknown and the risk factors are still being clarified, it is not possible to prevent rheumatoid arthritis. Many people with an inherited risk of rheumatoid arthritis never develop the disease.
Although very rare, rheumatoid arthritis can lead to complications that require prompt medical attention. Rheumatoid arthritis can lead to serious and even potentially life-threatening complications. Immune reactions can inflame a number of different tissues, and any sudden symptoms, such as chest or abdominal pain, warrant prompt medical attention. Rheumatoid arthritis can inflame the bones of the upper spine, which protects the delicate spinal cord. Any numbness, tingling, or electric shock sensations in the upper extremities that occur with neck movement also requires prompt medical attention.
People with rheumatoid arthritis play a central role in the day-to-day management of their own disease. It is important for you to learn about this chronic disease and to take an active role in health care decisions and treatment. People may find that following an exercise plan, monitoring their own symptoms, and other such self care techniques allow them to gain a sense of control over their disease. Because rheumatoid arthritis varies so much from person to person, patients will always be more knowledgeable in the daily personality of his or her disease than even their doctor.
Rest, stress reduction, flexibility, and self-awareness can help people cope with the physical and emotional effects of rheumatoid arthritis. Rheumatoid arthritis can affect all aspects of daily life, and can trigger anxiety and depression. Your health care provider will provide you with certain strategies to help you cope with the physical and emotional effects of this disease.
Adequate rest is essential for dealing with fatigue. Stress reduction can eliminate this source of strain on the body, and may even decrease your perception of pain. A willingness to make lifestyle adjustments can also help you to adapt to the unpredictability of rheumatoid arthritis. In some cases, a daily journal can help pinpoint factors that worsen and improve symptoms.
Gentle and appropriate exercise can help to maintain joint range of motion, muscle strength, and overall endurance. If you remain inactive, you are likely to lose even more mobility and strength. Moderate physical activity is strongly encouraged, because it is both physically and emotionally good for you. Exercise also has mood-elevating benefits, and may decrease pain. A doctor and a physical therapist can help tailor a safe and effective exercise program. Non-weight-bearing physical activities, such as swimming and bicycling, are often the best choices for people with rheumatoid arthritis.
Supportive relationships can help you meet the challenges of rheumatoid arthritis. It is important to maintain your personal relationships, even if you feel down or depressed. Family and friends can often provide both physical and emotional assistance. Support groups can provide a forum for sharing information, experiences, and resources.
A well-balanced and nutritious diet supports overall health. Maintaining a healthy weight will benefit your joints; especially if you have rheumatoid arthritis in your legs. Although there is no evidence that your diet, whether good or bad, plays a direct role in the activity of rheumatoid arthritis, a well-balanced and nutritious diet is essential for maintaining good health, and is always an excellent way that you can take care of yourself.
More recent research suggests that diet, in combination with your physician’s advice, may help the symptoms of some autoimmune diseases. There is the general diet, the Autoimmune Protocol (AIP) and more specific diets such as Hashimoto’s Diet.
Your doctor is the best source of information on the drug treatment choices available to you.
Splints and braces help rest inflamed joints. Joints inflamed by rheumatoid arthritis are vulnerable to injury; however, injury can result from even routine motions of the joint. Resting the joints by immobilizing them with splints and braces can help protect these structures from accidental injury.
Use of hot packs and cold packs can help alleviate symptoms. Hot packs and cold packs may help alleviate pain, muscle spasms, and inflammation. However, it is important to obtain guidelines about their correct use because these therapies can actually be harmful when used at the wrong time or for too long.
Therapies such as hydrotherapy and massage can make your muscles feel relaxed, and can help you to maintain flexibility. Hydrotherapy immersion in water, with or without exercise can relax muscles, take weight off the joints, and help relieve pain. If you don’t have access to a pool, gentle massage performed by a licensed professional can also be a safe and effective way of relaxing muscles and maintaining flexibility.
Specialized shoes, specialized shoe inserts (orthotics), and neck collars can support and protect unstable joints. Specialized shoes and orthotic inserts, which must be made specifically for you, can help protect feet that have been affected by rheumatoid arthritis. Neck collars can help stabilize the upper spine and prevent spinal cord damage in people who have instability of the cervical spine.
Crutches, canes, and assertive devices can make routine activities easier. Crutches and canes may help relieve stress on weight-bearing joints. Assertive devices, such as specialized utensils and hand rails, can also make daily life easier. An occupational therapist can recommend certain lifestyle adjustments and devices based on a your degree of disability.
Surgery can help alleviate pain, correct deformities, and sometimes restore function in severely damaged joints. Surgery can provide several benefits if you have had advanced joint damage from rheumatoid arthritis. Different types of surgery are often recommended for different joints.
Total joint replacement is the most common type of surgery recommended for rheumatoid arthritis in the hips, knees, and shoulders. Replacement of the damaged joint with an artificial joint made of plastic and metal can markedly alleviate pain and restore function.
Other types of surgery are recommended for the hands, feet, and wrists. Reconstructive surgery is often recommended for the hands. This surgery can realign the hand, relieve pain, and improve function. Surgery is often used to prevent or treat tendon damage.
Arthrodesis, surgical fusion of the bones to permanently prevent motion, is often recommended for the joints of the ankles and feet.
Carpal tunnel surgery can relieve pressure on a nerve that travels through the wrist.
Synovectomy, surgical removal of the inflamed lining of the joint (synovium), can temporarily relieve pain in specific joints; however, the synovium usually grows back over time.
At this time, most alternative practices have no proven benefit for helping rheumatoid arthritis. Because rheumatoid arthritis fluctuates from flares to remission, you can easily be convinced that a particular alternative treatment is working. These therapies must be put to the same scientific testing that FDA approved drugs have been put through before they are deemed effective. It is important to remember that the fluctuation of pain and inflammation is characteristic of the disease, and mat not be attributed to any one therapy.
Although the promises of alternative practices may sound attractive, these practices are not a substitute for the medical treatment of rheumatoid arthritis. The safety and effectiveness of taking some herbs is unknown, and these therapies can be financially draining and potentially harmful. When considering alternative medicine, it’s important to research specific practices, to use good common sense, and to consult with a doctor first.
Omega-3 fatty acids, zinc, and vitamin E may alleviate symptoms in some people. Taking omega-3 fatty acids (found in certain plant and fish oils) may improve symptoms in people with rheumatoid arthritis by working in similar ways to NSAIDs.
If you notice that your rheumatoid arthritis consistently flares when you eat a certain food, eliminating that food is a probably a good idea. However, it is important to eat a balanced diet to maintain proper nutrition. Speak with your health professional before making any significant changes in what you eat, such as eliminating an entire food group.
Certain alternative practices, such as yoga and meditation, can help alleviate stress and manage pain. Your emotional status and outlook play a large role in the overall management of rheumatoid arthritis. Safe, alternative practices that have relaxing, soothing, and revitalizing effects can help alleviate stress and manage pain.
Rheumatoid arthritis varies widely in its severity. The severity and the length of time you suffer from rheumatoid arthritis can be strikingly different from person to person. You may have minor joint pain that quickly resolves, whereas another person may develop severe joint damage and disability. Unfortunately, there is no certain way to predict how severe or prolonged rheumatoid arthritis will be in each person. Thus an aggressive treatment regimen is crafted for each individual and changes are made over time, depending upon your response and disease characteristics.
Although it is impossible to predict the course of rheumatoid arthritis, certain factors seem to play a role in the severity and duration of the disease. Early and aggressive treatment of rheumatoid arthritis usually means a better prognosis. However, the presence of rheumatoid factor, particularly at high levels, is associated with more severe joint damage and complications in other organs and tissues.
If you have inflammation in more than 20 joints, you are more likely to have severe joint damage. Other factors that seem to indicate likelihood for severe joint damage are serious inflammation that persists for more than one year, being over the age of 60 years at the time of diagnosis, or having x-rays that show evidence of bone damage.
The joint damage of rheumatoid arthritis progresses most rapidly in the first years of disease, and gradually subsides over time. Within two years of diagnosis, about 70% of people have some signs of joint damage on x-rays. Loss of physical function is also most severe in the first few years of disease, a loss which tends to progress over time.
About 15% of people with rheumatoid arthritis are fortunate to have symptoms that lead to only minor loss of function. However, over time, most untreated patients develop some degree of joint damage and loss of function.
Most cases of rheumatoid arthritis are characterized by a pattern of painful flare ups (relapses) and less painful periods (remissions), where the disease does not seem to be a major problem. If remission is going to occur, it is most likely to occur in the first year of disease.
Regular medical visits are essential if you have rheumatoid arthritis. Regular medical visits to your primary care doctor or your rheumatologist are essential for monitoring the success and side effects of treatment, and for assessing and maintaining optimal overall health. Your doctor may have to periodically adjust your treatment plan.