Rheumatoid Arthritis Symptoms, Causes, Diagnosis, and Treatment

What Is Rheumatoid Arthritis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

What Is Rheumatoid Arthritis? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Everyday Health

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints. Within the body, joints are the points where bones come together and allow for movement. Synovial joints are the most common joints in the body, and these also provide shock absorption.

RA is an autoimmune condition in which your immune system mistakes the linings of your joints as “foreign” and attacks and damages them, resulting in inflammation and pain.

This disease most often affects the joints of the hands, wrists, and knees symmetrically. There is no cure, but RA can be managed with good treatment, according to the Centers for Disease Control and Prevention (CDC).

Signs and Symptoms of Rheumatoid Arthritis

RA is a complex disease that is not well understood by medical practitioners or researchers.

Early signs of the disease, such as joint swelling, joint pain, and joint stiffness, typically begin in a gradual and subtle way, with symptoms slowly developing over a period of weeks to months and getting worse over time. RA usually begins in the small bones of the hands like those at the base and middle of the fingers, base of the toes, and wrists. Morning stiffness that lasts more than an hour is common, according to University of Florida Health.

RA is a progressive disease. When left untreated, inflammation can start to develop in other parts of the body, causing various potentially serious complications that can affect other organs, such as the heart, lungs, and nerves, and could cause significant long-term disability.

If you're experiencing RA symptoms, it's crucial to get diagnosed as soon as possible so that you can receive prompt treatment.

Causes and Risk Factors of Rheumatoid Arthritis

RA develops when white blood cells, which normally protect the body from foreign invaders such as bacteria and viruses, enter the synovium (the thin tissue that lines the synovial joints). Inflammation ensues: The synovium thickens, causing swelling, redness, warmth, and pain in the synovial joint.

Over time, the inflamed synovium can damage the cartilage and bone within the joint, as well as weaken supportive muscles, ligaments, and tendons.

Researchers don't know exactly what causes the immune system to invade the synovium, but it's believed that genes and environmental factors play a role in the development of RA.

Is Rheumatoid Arthritis Hereditary?

Research suggests that people with certain genetics, namely the human leukocyte antigen genes, have a significantly increased risk of developing RA. The human leukocyte antigen gene complex controls immune responses by producing proteins that help the immune system recognize proteins from foreign invaders.

A number of other genes also appear to be associated with RA susceptibility, including STAT4, PTPN22, TRAF1-C5, PADI4, and CTLA4, among others, according to a report published in the journal Annals of Medicine and Surgery.

Environmental Triggers

But not everyone with these identified gene variants develops RA, and people without them can still develop it. So, it's likely that environmental factors often trigger the disease, particularly in people with a genetic makeup that makes them more susceptible to it. These factors include:

  • Viruses and bacteria (though certain infections may reduce RA risk, at least temporarily)
  • Some female hormones
  • Exposure to certain kinds of dust and fibers
  • Exposure to secondhand smoke
  • Obesity, which also increases progression of disability for people with RA. Patients with obesity are less likely to achieve RA remission regardless of the treatment they receive.
  • Severely stressful events
  • Certain foods

Equally important are smoking and a family history of RA in increasing a person's risk of developing the condition.

How Is Rheumatoid Arthritis Diagnosed?

While no single test can definitively diagnose RA, doctors consider several factors when evaluating a person for rheumatoid arthritis.

The diagnostic process typically begins when a doctor gets your medical history and conducts a physical exam. They will ask you about your symptoms to look for signs of RA, in particular things like prolonged joint swelling and morning stiffness that lasts at least half an hour after you wake up.

Next, your doctor will order blood tests to detect rheumatoid factor and anticitrullinated protein antibodies (ACPAs), which can be specific markers for and could indicate RA. You can still have symmetrical inflammatory arthritis with or without systemic markers of inflammation.

Imaging tests such as X-ray, ultrasound, and magnetic resonance imagery scans may be used to help a doctor determine if your joints have been damaged or to detect joint inflammation, erosion, and fluid buildup.

In the future, doctors may be able to diagnose RA using (noninvasive) infrared light.

The Different Types of Rheumatoid Arthritis

Rheumatoid arthritis is classified as either seropositive or seronegative.

People with seropositive RA have ACPAs found in their blood. These antibodies attack the synovial joints and produce symptoms of RA.

About 60 to 80 percent of people diagnosed with RA have ACPAs, and for many people, the antibodies precede the symptoms of RA by 5 to 10 years, according to the Arthritis Foundation.

People with seronegative RA have the disease without the presence of the antibodies or rheumatoid factor in their blood.

Duration of Rheumatoid Arthritis

RA is a progressive and chronic disease. Damage to the joint bones occurs very early in the progression of the disease, typically within the first two years, according to the Johns Hopkins Arthritis Center.

 That's why early treatment is so important.
With effective early treatment, most people with RA can live as they normally would, and many people can achieve remission of symptoms. This doesn't mean that you're cured but rather that your symptoms are alleviated to the point where you can function at your fullest and your joints are not being further damaged by RA. It's also possible to achieve remission and then relapse, or have your symptoms return.

Remission doesn't happen for everyone, and because the pain and other symptoms of RA may change over time, pain management can be an ongoing concern. In addition to pain medications like nonsteroidal anti-inflammatory drugs and corticosteroids, there are many options for pain relief for people living with RA. These include:

Treatment and Medication Options for Rheumatoid Arthritis

To treat RA, doctors aim to stop the progression of the disease by reducing symptoms, controlling inflammation, minimizing joint and organ damage, and improving physical function.

Proven treatments include medication and physical therapy. Early, aggressive measures can help control symptoms and complications before the disease significantly worsens, by reducing or altogether stopping inflammation as quickly as possible.

This strategy is essential to mitigating debilitating symptoms, and it usually amounts to treatment with anti-inflammatory drugs, and sometimes more than one medication at a time.

Medication Options

In recent years, there have been significant advancements in medicines for treating RA, but there is still no cure. Medications known as disease-modifying antirheumatic drugs (DMARDs) are a class of immunomodulatory agents indicated for the treatment of inflammatory arthritides such as rheumatoid arthritis.

In general, these drugs work by slowing the inflammation and protecting the joints from further damage, and are generally prescribed shortly after diagnosis. The type of DMARD a doctor prescribes depends on several factors, including disease severity and the balance between the medication's benefits and potential side effects.

Biologics and janus kinase inhibitors (JAK) inhibitors are options alongside traditional DMARDs.

Traditional DMARDs target the entire immune system, while biologics work by targeting specific steps in the inflammatory process, and JAK inhibitors block action in your body to help prevent the inflammation before it starts. Traditional DMARDs are usually taken in pill form, as are JAK inhibitors; biologics are typically injected or delivered via an intravenous infusion.

JAK inhibitors can increase the risk of serious heart-related events such as heart attack or stroke, as well as cancer, blood clots, and death, especially among those with existing heart conditions.

 “Rheumatologists should carefully consider the cardiovascular risks when prescribing JAK inhibitors, particularly tofacitinib, for RA patients,” according to a study published in Frontiers in Pharmacology.

Nonsteroidal anti-inflammatory drugs and corticosteroids are used to treat pain and inflammation.

However, low doses are recommended as some patients may suffer serious side effects with extended use.

Alternative and Complementary Therapies for Rheumatoid Arthritis

Certain lifestyle changes and home remedies may be beneficial — in addition to the conventional treatment of medication, physical therapy, and surgery — if needed.

Some people have found relief from RA symptoms through acupuncture, tai chi, and yoga, though the scientific evidence supporting this isn't particularly conclusive. Complementary or alternative therapies, such as homeopathy, hydrotherapy, or cryotherapy, might also be worth considering to help relieve RA pain and stiffness.

“There is much evidence, although mostly of low or moderate quality about the positive effect of dynamic, aerobic exercise programs, muscle strengthening exercises in RA patients on pain, function, fatigue, quality of life,” according to a study published in Frontiers in Medicine in 2022.

Relaxation techniques, visualization exercises, group counseling, and psychotherapy can help reduce the stress of living with RA. Sleeping well is also an important part of managing symptoms.

You should always check with your medical provider before trying any complementary or alternative therapies.

Many people can manage RA with medication and physical therapy, but joint surgery may be an option if your joint damage is severe and limiting your quality of life.

Complications of Rheumatoid Arthritis

It's well established that rheumatic diseases such as RA increase the risks of developing a variety of health conditions.

One of the more common RA comorbidities is cardiovascular disease, but the condition is also associated with several specific cardiovascular issues, including heart attack, stroke, congestive heart failure, peripheral vascular disease, and atherosclerosis.

It's important for people with RA to work with their doctors to assess their heart disease risk factors, such as high blood pressure, diabetes, and smoking, and to reduce them.

RA can also lead to inflammation in other areas of the body, including blood vessels, which is known as rheumatoid vasculitis; the lungs, resulting in rheumatoid lung disease or other conditions; the eyes; and the wrists, causing carpal tunnel syndrome.

Another possible complication is kidney impairment as a result of RA medication. And pregnant women need to be aware that RA is linked to pregnancy complications, such as hypertension (high blood pressure) during late pregnancy and increased risk of premature delivery.

Dietary Modifications to Consider for Rheumatoid Arthritis

While there is a lot of interest in the role of diet and nutrition in symptom management for RA, there is no comprehensive research on the topic, nor is there a magic dietary formula to fight RA symptoms.

But some evidence suggests that eating certain foods may help reduce inflammation and improve symptoms for some people, while other foods have been shown to worsen inflammation and related symptoms.

On the other hand, the Mediterranean diet is high in seafood (omega-3 fatty acids) and fiber, which can help fight inflammation. It's sometimes called the anti-inflammatory diet or arthritis diet.

Who Has Rheumatoid Arthritis?

According to a study reporting results from the Global Burden of Disease Study 2019, there were an estimated 18.5 million cases of RA worldwide, having increased over the previous 30 years and set to increase until 2040.

Women are more likely than men to develop RA at an early age, and two to three times as many women as men develop RA, according to the CDC.

Inflammatory arthritis can affect children. It's known as juvenile idiopathic arthritis (JIA), and it affects nearly 300,000 children in the United States.

 JIA can't be diagnosed with a blood test, so doctors consider symptoms and medical history to rule out conditions that can resemble JIA, such as infections, cancer, Lyme disease, bone disorders, and lupus.

Conditions Related to Rheumatoid Arthritis

There are several kinds of arthritis (“arth” is Latin for “joint” and “itis” is Latin for “disease” or “inflammation”), including RA, osteoarthritis, gout, and lupus.

 Osteoarthritis is the most common type of arthritis, affecting more than 32.5 million Americans, according to the CDC.

Rheumatoid arthritis and osteoarthritis affect the body differently. In RA, the joint lining becomes inflamed and eventually erodes the joint. But in osteoarthritis, the cartilage that covers the ends of the bones in a joint is damaged by multiple causes, and it is considered more of a mechanical (wear and tear) disease.

There are other health conditions related to rheumatoid arthritis, too. Osteoporosis, or low bone density, as well as mental health conditions like anxiety and depression, are also common in people with RA.

Pulmonary conditions are linked to RA as well. An estimated 10 percent of people with RA will develop interstitial lung disease, according to the Arthritis Foundation.

Additionally, people with RA have an increased risk of lymphomas, possibly due to chronic inflammation.

Resources We Love

Favorite Orgs for Essential Rheumatoid Arthritis Information

The American College of Rheumatology is an organization for physicians, health professionals, and scientists that advances rheumatology through education, research, advocacy, and practice support relating to the care of people with arthritis and rheumatic and musculoskeletal diseases. It publishes two medical journals (Arthritis & Rheumatology and Arthritis Care & Research) and promotes research into rheumatological conditions.

The Arthritis Foundation is a nonprofit organization dedicated to the prevention, control, and cure of arthritis. The foundation provides information and resources, access to optimal care, advancements in science, and community networking.

CreakyJoints is a leading support, education, advocacy, and research organization for people living with arthritis and rheumatic disease. It is dedicated to raising awareness of all forms of arthritis, which includes educating people about the available varieties of treatment and management strategies.

Favorite Online Support Network for Rheumatoid Arthritis

Live Yes! Connect Groups, from the Arthritis Foundation, provide a network of support with the aim of helping people live their best lives. By exchanging ideas, tips, and experiences with others in provided online forums covering a variety of topics, the network empowers people with RA to gain confidence in dealing with their disease proactively.

Favorite Apps, Products, and Gadgets

Dycem Super Grip Tape, $13.95

Dycem's self-adhering Super Grip Tape provides a cushioned grip that feels more comfortable on the hands. The tape adheres to a variety of surfaces, including brooms, wheelchair arms, mobility devices, and even pens and cutlery. The nonslip grip will help increase the friction of any surface you grab.

Hamilton Beach Smooth Touch Electric Automatic Can Opener, $39.95

The Smooth Touch can open both pop-top and regular cans. It is designed so that it cuts along the side of the can and not the top, minimizing the blade's contact with food, preventing splashing, and creating a smooth, touchable lid.

Copper Compression Arthritis Gloves, $25.95

Many people with RA consider compression gloves a must-have accessory. According to research,

hand symptoms including pain, stiffness, and swelling improve greatly with the use of compression gloves. Copper Compression Arthritis Gloves are one of Amazon’s top sellers for arthritis gloves.

IMAK Compression Arthritis Gloves, $18.99

IMAK remains one of the easiest brands of compression gloves to find, both online and in stores.

Sunbeam Heated Blanket

Sunbeam's electric blanket can help those with arthritis get off to a better start in the morning by providing the heat necessary to loosen stiff joints. An easy-to-use controller can adjust the blanket through 12 heating levels to help you warm up your joints before getting out of bed. The blanket comes in twin, full, queen, and king sizes to fit all standard-size beds.

Favorite Patient Blogs

Chronic Eileen

Over a period of two and a half years, Eileen Davidson was diagnosed with RA, osteoarthritis, and fibromyalgia. She began writing Chronic Eileen in June 2017 as a way to battle her struggles with progressing anxiety and depression and to help her handle her new role as a mother with a chronic illness (her article on parenting techniques is definitely worth a read). Her posts share many of these ideas, such as whether arthritis will make tattoos hurt or how to calm the “bitch within” when living with a chronic illness.

From This Point. Forward.

Mariah Leach was diagnosed with RA at age 25 while pursuing dual graduate degrees. Since then, she has without a doubt made the most of living with a chronic illness, including giving birth to three children. In addition to her blog, Leach writes for various health websites. On Mamas Facing Forward, she pays special attention to mothers living with RA in articles on sex, parenting, treatment, and ordinary life with RA.

Favorite Annual Meeting

American College of Rheumatology Annual Meeting

Every year, nearly 16,000 rheumatologists, rheumatology health professionals, fellows in training, patient advocates, and exhibitors from more than 100 countries gather to discuss the latest scientific advances and clinical issues surrounding RA. The annual convention hosts sessions that provide ample opportunity for professional development, networking, and access to the latest rheumatology research and clinical applications.

FAQ

What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic autoimmune condition in which your immune system mistakes the linings of your joints as foreign and attacks them. The damage results in inflammation and pain.
Rheumatoid arthritis inflames the joint lining, eventually eroding the joint. With osteoarthritis, multiple causes may damage the cartilage that covers the ends of the bones in a joint. The most common type of arthritis, osteoarthritis, is considered more of a mechanical (wear and tear) disease.
No single test can diagnose rheumatoid arthritis. Doctors consider symptoms such as joint swelling and morning stiffness. Blood tests detect rheumatoid factor and anti-citrullinated protein antibodies, which are markers for systemic inflammation. X-ray, ultrasound, and magnetic resonance imaging scans can help determine joint health.
Rheumatoid arthritis is not generally considered a lethal disease. The disease can usually be managed with medication.
Exercise is an essential aspect of rheumatoid arthritis treatment, consisting of stretching, aerobics, and strength training. For pain and inflammation, try heat treatment to soothe stiff joints, or cold treatments for acute pain, as well as over-the-counter topical ointments and specialized braces or splints that support the joints.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  19. Osteoarthritis. Centers for Disease Control and Prevention. January 26, 2024.
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  22. Nasir SH et al. Therapy Gloves for Patients With Rheumatoid Arthritis: A Review. Therapeutic Advances in Musculoskeletal Disease. November 4, 2014.
Sian-Yik-Lim-bio

Sian Yik Lim, MD

Medical Reviewer
Sian Yik Lim, MD, is a board-certified rheumatologist at Hawaii Pacific Health. He is a clinical certified densitometrist, certified by the International Society of Clinical Densitometry. He completed his rheumatology fellowship at Massachusetts General Hospital and was also a research fellow at Harvard Medical School. His research interests include osteoporosis, gout, and septic arthritis. Dr. Lim has published in JAMA, Current Opinions in Rheumatology, Osteoporosis International, Bone, Rheumatology, and Seminars in Arthritis and Rheumatism.

Lim has authored several book chapters, including one titled “What is Osteoporosis” in the book Facing Osteoporosis: A Guide for Patients and their Families. He was also an editor for Pharmacological Interventions for Osteoporosis, a textbook involving collaboration from a team of bone experts from Malaysia, Australia, and the United States.

Joseph Bennington-Castro

Author

Joseph Bennington-Castro is a science writer based in Hawaii. He has written well over a thousand articles for the general public on a wide range topics, including health, astronomy, archaeology, renewable energy, biomaterials, conservation, history, animal behavior, artificial intelligence, and many others.

In addition to writing for Everyday Health, Bennington-Castro has also written for publications such as Scientific American, National Geographic online, USA Today, Materials Research Society, Wired UK, Men's Journal, Live Science, Space.com, NBC News Mach, NOAA Fisheries, io9.com, and Discover.