Also known as: RA and Arthritis - rheumatoid
- Morning stiffness, which lasts more than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour.
- Joint pain is often felt on the same joint on both sides of the body.
- Over time, joints may lose their range of motion and may become deformed.
- Rheumatoid factor test
- Anti-CCP antibody test
- Methotrexate (Rheumatrex) is the most commonly used DMARD for rheumatoid arthritis. Leflunomide (Arava) and chloroquine may also be used.
- These drugs may have serious side effects, so you will need frequent blood tests when taking them.
- Although NSAIDs work well, long-term use can cause stomach problems, such as ulcers and bleeding, and possible heart problems.
- Celecoxib (Celebrex) is another anti-inflammatory drug, but it is labeled with strong warnings about heart disease and stroke. Talk to your doctor about whether COX-2 inhibitors are right for you.
- White blood cell modulators include: abatacept (Orencia) and rituximab (Rituxan)
- Tumor necrosis factor (TNF) inhibitors include: adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), golimumab (Simponi), and certolizumab (Cimzia)
- Interleukin-6 (IL-6) inhibitors: tocilizumab (Actemra)
- Removal of the joint lining (synovectomy)
- Total joint replacement in extreme cases; may include total knee, hip replacement, ankle replacement, shoulder replacement, and others
- Damage to the lung tissue (rheumatoid lung)
- Increased risk of hardening of the arteries
- Spinal injury when the neck bones become damaged
- Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
- Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead to congestive heart failure
Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs.The first symptom of rheumatoid arthritis (RA) is most often:The correct answer is pain in the joints of the hands and feet. RA often starts in the small joints of the fingers and toes. As the arthritis becomes worse, the pain spreads to joints in the ankles, elbows, hips, knees, and shoulders. If you think you may be having symptoms of RA, see your doctor. RA usually develops slowly.The correct answer is true. The symptoms of RA most often begin slowly over weeks to a few months. You may notice fatigue and minor joint pain and stiffness, most likely in the morning. Over time, the symptoms can change or become more severe. Ask your doctor about ways to help control symptoms. The symptoms of RA can come and go.The correct answer is true. Some people have periods when they have no symptoms at all. These are called remissions. Then they might have periods when the symptoms are worse, called flares. Work with your doctor to figure out what might trigger your flares. Along with joint pain and swelling, RA can also cause:The correct answer is all of the above. Other symptoms of RA can include fatigue, nodules under the skin, loss of appetite, and numbness or tingling in the hands or feet. If you have joint pain and any of these symptoms, talk to your doctor. Everyone with RA usually has all of the symptoms.The correct answer is false. The symptoms of RA can vary widely from person to person. Your symptoms may also change day-to-day as your RA progresses. Ask your doctor about any new or unusual symptoms. People with RA usually feel best in the morning.The correct answer is false. The joint stiffness caused by RA is usually worst in the morning. This is one clue to diagnosing RA, since people with other types of arthritis usually feel less pain in the morning. RA symptoms occur in the same joint on both sides of the body.The correct answer is true. RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the joints most often affected. RA is caused by wear and tear on your joints:The correct answer is false. RA is an autoimmune disease. This means the body's immune system mistakenly attacks healthy tissue in your joints. Over time, RA can cause your joints to become deformed. This is one reason why it's important to talk to your doctor if you think you have RA. Early treatment can help prevent joint damage. RA can also affect the lungs, heart, or eyes.The correct answer is true. The inflammation that causes RA can also affect other organs, such as the lungs, heart, or eyes. Over time, RA can cause damage to these organs. Getting early treatment for RA can help reduce your risk for these problems. It's easy to diagnose RA.The correct answer is false. Early on, symptoms of RA are often similar to other bone and joint problems. Diagnosing RA can be tricky. And there's no one test for RA. To diagnose RA, your doctor will review your symptoms and may run tests to look for markers of RA. Most people with RA begin having symptoms in their 30s.The correct answer is false. Most people with RA first notice symptoms between the ages of 40 and 60. However, people of all ages can get RA. If you have any symptoms of RA, no matter what your age, see your doctor.
Causes, incidence, and risk factors
The cause of RA is unknown. It is an autoimmune disease, which 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.
RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected.
The disease often begins slowly, usually with only minor joint pain, stiffness, and fatigue.
Joint symptoms may include:
Other symptoms include:
Signs and tests
There is no test that can determine for sure whether you have RA. Most patients with RA will have some abnormal test results, although for some patients, all tests will be normal.
Two lab tests that often help in the diagnosis are:
Other tests that may be done include:
RA usually requires lifelong treatment, including medications, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA can delay joint destruction.
Disease modifying antirheumatic drugs (DMARDs): These drugs are the first drugs usually tried in patients with RA. They are prescribed in addition to rest, strengthening exercises, and anti-inflammatory drugs.
Anti-inflammatory medications: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naprosen.
Antimalarial medications: This group of medicines includes hydroxychloroquine (Plaquenil), and is usually used along with methotrexate. It may be weeks or months before you see any benefit from these medications.
Corticosteroids: These medications work very well to reduce joint swelling and inflammation. Because of long-term side effects, corticosteroids should be taken only for a short time and in low doses when possible.
Biologic drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis.
They may be given when other medicines for rheumatoid arthritis have not worked. At times, your doctor will start biologic drugs sooner, along with other rheumatoid arthritis drugs.
Most of them are given either under the skin (subcutaneously) or into a vein (intravenously). There are different types of biologic agents:
Biologic agents can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:
Occasionally, surgery is needed to correct severely damaged joints. Surgery may include:
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.
Joint protection techniques, heat and cold treatments, and splints or orthotic devices to support and align joints may be very helpful.
Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night, are recommended.
Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eating foods rich in fish oils (omega-3 fatty acids).
How well a person does depend on the severity of symptoms.
People with rheumatoid factor, the anti-CCP antibody, or subcutaneous nodules seem to have a more severe form of the disease. People who develop RA at younger ages also seem to get worse more quickly.
Without proper treatment, permanent joint damage may occur. However, early treatment with many of the newer medicines have decreased joint pain and damage.
Rheumatoid arthritis can affect nearly every part of the body. Complications may include:
The treatments for RA can also cause serious side effects. Talk to your doctor about the possible side effects of treatment and what to do if they occur.
Calling your health care provider
Call your health care provider if you think you have symptoms of rheumatoid arthritis.
There is no known prevention. Proper early treatment can help prevent further joint damage.
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Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010 Sep 25;376(9746):1094-108.
Harris ED Jr, Firestein GS. Clinical features of rheumatoid arthritis. In: Firestein GS, Budd RC, Harris ED Jr, et al., eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 66.
McBeth J, Prescott G, Scotland G, Lovell K, Keeley P, Hannaford P, et al. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain.Arch Intern Med. 2011 Nov 14.
- Review date:
- February 2, 2012
- Reviewed by:
- Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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