Rheumatoid Arthritis

What is rheumatoid arthritis? 

Rheumatoid arthritis (RA) is an autoimmune disease where your immune system attacks healthy cells in your body and causes inflammation. It’s the most common type of inflammatory arthritis.

Rheumatoid arthritis is different from osteoarthritis, which is the “wear-and-tear” type of arthritis that many people get as they get older. People can get rheumatoid arthritis at any age, but it most commonly appears between 30 to 50 years of age. Women are affected more often than men.

RA causes swelling in the lining of your joints, which can lead to joint pain, joint damage and decreased flexibility and deformity, most often in the small joints of the hands, wrists, fingers, ankles and feet. 

As the disease progresses, it can spread to larger joints, such as the knees, elbows, shoulders, hips, spine and jaw. The inflammation from RA can also affect other parts of the body, such as the eyes, heart, skin, blood vessels and lungs. 

RA is a chronic condition, which means it can’t be cured. However, early diagnosis and proper treatment can help to control symptoms and make long-term complications less likely.

What causes rheumatoid arthritis?

We know that when you have RA, your body’s immune system mistakes healthy cells for cells it’s designed to fight, such as viruses and bacteria, and attacks them with inflammatory substances. 

With RA, the immune system targets a lining around joints called the synovium, which then becomes thickened and releases chemicals that damage the cartilage and bone. Over time, the muscles, ligaments and tendons around joints can weaken as well.

It’s not clear why your body’s immune system reacts this way. It’s possible that a combination of genetics, environmental factors, stress or viral or bacterial infections can trigger RA. Your immune system could be reacting for years before you notice any symptoms. 

Who is at risk for rheumatoid arthritis?

• edimentation rate (ESR), C-reactive protein, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
• Joint aspiration to look for other causes of inflammation, such as infection or gout.

Several factors increase your risk of developing RA: 

• Age: Most people develop RA between ages 30 and 50. 
• Sex: Women are two to three times more likely to develop RA than men. 
• Family history: RA risk is higher if a close relative has the condition. 
• Genetics: Certain genes may increase your chances of getting RA and having more severe symptoms. 
• Smoking: Smoking raises your risk and can make symptoms worse. 
• Obesity: A BMI of 30 or higher increases your risk. 
• Childhood exposures: Risk may be higher if your mother smoked or if you had limited education, though the reasons are unclear. 
• Gum or lung disease: Chronic inflammation in these areas is linked to higher RA risk.

Common symptoms of rheumatoid arthritis  

RA symptoms can appear quickly or develop over years. They often come and go, with flares (active periods) and remissions (periods of little or no symptoms). 

Symptoms include: 

• Pain, swelling, stiffness or tenderness in multiple joints (usually small joints in the hands or feet) 
• Symptoms on both sides of the body (for example, both wrists or both knees) 
• Joints that feel warm, red or swollen 
• Stiffness after waking up or being still 
• Fatigue and weakness 
• Weight loss or loss of appetite 

If joint symptoms last more than six weeks or seem to affect both sides of your body, talk to your doctor. 

How is rheumatoid arthritis diagnosed?

If you have symptoms of RA, your doctor may recommend that you see a rheumatologist, a doctor who specializes in diagnosing and treating arthritis. Tell your doctor about all your symptoms even if they don’t seem related, since RA can affect different parts of your body.

Getting the right diagnosis is crucial because other inflammatory joint diseases can have similar symptoms to RA, especially in its early stages. Your doctor may observe your symptoms over time before diagnosing RA.

Diagnosis often includes:

• Medical history: Includes your symptoms and any family history of RA. 
• Physical exam: To check for joint swelling or other signs of inflammation. 
• Imaging: X-rays or ultrasound can reveal joint damage. 
• Blood tests: These may include ESR, C-reactive protein, rheumatoid factor (RF) and anti-CCP antibodies. 
• Joint aspiration: To rule out other causes like infection or gout.  

If you have symptoms of RA, seek care promptly. Getting diagnosed and starting treatment within six months of diagnosis can help reduce long-term damage.

How is rheumatoid arthritis treated?

There is no permanent cure for RA, but treatment can reduce pain, slow disease progression and improve quality of life. Your health care provider will work with you to create a personalized plan.

RA treatment options include:

• NSAIDs: Over-the-counter medications like ibuprofen, naproxen, meloxicam or celecoxib can reduce short-term pain and inflammation.
• DMARDs (Disease-Modifying Antirheumatic Drugs): Help slow the disease and prevent joint damage. These include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine.
• Biologics: Target specific parts of the immune system. Examples include adalimumab (Humira), etanercept (Enbrel), abatacept (Orencia), tocilizumab (Actemra) and rituximab (Rituxan).
• JAK inhibitors: Used if DMARDs or biologics aren’t effective. These include tofacitinib (Xeljanz), baricitinib (Olumiant) and upadacitinib (Rinvoq).
• Corticosteroids: Short-term relief for pain and swelling. Examples include prednisone and hydrocortisone.

Therapies and devices

• Physical or occupational therapy to keep joints flexible and muscles strong
• Assistive tools like jar openers, special utensils or doorknob covers
• Splints to support joints and prevent deformity

Surgical options

If other treatments don’t work, surgery may help reduce pain or improve function. Options include:

• Removing the joint lining (synovectomy)
• Repairing tendons
• Fusing joints
• Joint replacement

Talk to your doctor about whether surgery is right for you. 

What are the complications from rheumatoid arthritis?

RA can have harmful long-term effects on your health and well-being. People with rheumatoid arthritis are more likely to develop heart disease, and this risk increases for people who are obese. People who are obese often don’t get as much benefit from their treatments as people who are not.

If you have RA, you’re also more likely to develop:

• Joint deformity.
• Rheumatoid nodules, which are hard tissue bumps that tend to appear on fingers and knuckles, elbows, knees, and forearms. Rarely, they can also form in the eyes, vocal cords and internal organs, such as the lungs.
• Osteoporosis, or weakening of the bones, which can be caused by RA and by the medications used to treat it.
• Heart problems such as blocked or hardened blood vessels or inflammation near your heart.
• Lung disease and lung-tissue scarring that can cause shortness of breath.
• Inflamed blood vessels, which can damage your skin and nerves.
• Low levels of red blood cells, which transport oxygen from the lungs to the body.
• Infections, since RA and medications used to treat RA can suppress your immune system 
• Lymphoma, a type of blood cancer.
• Sjögren’s syndrome, which causes dry eyes and mouth.
• A higher proportion of body fat, even with a normal BMI.

RA and carpal tunnel syndrome 

RA and carpal tunnel syndrome are separate conditions, but they can be connected. Swelling in the wrists from RA may put pressure on nerves and lead to carpal tunnel symptoms.

RA can affect your life in other ways as well. For example, it can be hard to stay employed if you have RA, especially as the disease gets worse. It’s especially challenging for people with physically demanding jobs to work if they have RA.

Managing rheumatoid arthritis and improving daily life  

While there's no cure, there are ways to improve your quality of life:

• Get at least 150 minutes of physical activity weekly. Try walking, swimming or cycling.
• Join an arthritis education class.
• Connect with others through support groups.
• Use heat or cold packs for joint pain.
• Track symptoms, diet, activity and mood to spot flare triggers.
• Stay current on vaccines and avoid illness.
• Quit smoking with help from a cessation program.
• Practice stress-reducing techniques like deep breathing, meditation or massage.
• Eat a healthy diet. Some people benefit from an anti-inflammatory or Mediterranean-style diet.
• Follow your doctor’s treatment plan.
• Rest when needed and know your limits.
• Ask family or friends for help when you need it. 

Schedule an appointment with a rheumatologist

If you’re experiencing joint pain, swelling, stiffness or fatigue that won’t go away, it may be time to talk to a specialist. 

At Banner Health, our expert rheumatologists can evaluate your symptoms, confirm a diagnosis, and create a personalized treatment plan to help you feel better and stay active. 

Don’t wait—early treatment can help prevent joint damage and improve your quality of life. 

Schedule an appointment with a Banner Health rheumatologist today.