Rheumatoid Arthritis (RA)

Symptoms, Doctors, Treatments, Advances & More

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that mainly affects the lining of joints of the hands, wrists, and knees, eventually causing chronic pain and swelling, decreased movement, with the erosion of bones and the development of joint deformities.  Rheumatoid arthritis is the most common type of autoimmune arthritis, most often affecting women (75%) who are between 20 and 50 years of age. The disease can also affect other parts of the body, such as the blood vessels, skin, eyes, lungs, and heart.   There are two main types of rheumatoid arthritis: 1) seropositive rheumatoid arthritis, and 2) seronegative rheumatoid arthritis. While both types of rheumatoid arthritis have the same symptoms, the seropositivity or negativity of the disease refers to the presence of anti-CPP antibodies in the blood, for which their presence means that the immune system is attacking normal cells. Most rheumatoid arthritis is seropositive.

Alternative names for rheumatoid arthritis include Arthritis, juvenile RA, RA, seronegative RA, and seropositive RA.

While the exact cause of rheumatoid arthritis is unknown, it is an autoimmune disease, which means that genes may play a role in the development of the disease, by making some people more susceptible to environmental factors or viruses or bacteria that may trigger it. However, some researchers also believe that it is a virus that triggers the autoimmune response in rheumatoid arthritis. In addition to being an autoimmune disease and having genetic factors, rheumatoid arthritis has several risk factors that may also increase the chances of developing the disease, such as gender, with the disease occurring more often in women as well as women who have never given birth, being middle-aged, having a family history of rheumatoid arthritis, inheriting the HLA (human leukocyte antigen) class II genes, smoking, childhood exposure to smoking, exposure to environmental toxins, such as asbestos or silica, and obesity.

Rheumatoid arthritis has several symptoms that may involve the joints and surrounding tissues; however, the disease can also often affect other parts of the body as the disease progresses. Symptoms include fatigue, fever, loss of appetite, dry eyes and mouth, joint stiffness that is worse in the morning and after being inactive, tender, warm, and swollen joints, or pain or aching in more than one joint, lumps under the skin of the elbows or hands (rheumatoid nodules), sleep problems, and depression. Early rheumatoid arthritis usually first affects the small joints, such as the phalanges (bones) that attach to fingers and toes. Later stage rheumatoid arthritis may spread to the wrists, elbows, shoulders, ankles, knees, and hips and can cause joint deformities and malalignments. Characteristically, rheumatoid arthritis usually occurs symmetrically, meaning that it often appears on both sides of the body. Symptoms of rheumatoid arthritis may alternately improve and worsen over time (remissions and flares). Many patients with rheumatoid arthritis (40%) have symptoms that affect other parts of the body, such as the skin, blood vessels, eyes, salivary glands, kidneys, lungs, heart, nerves, and bone marrow.

While there is no cure for rheumatoid arthritis, some patients can achieve remission when treated early with medications known as disease-modifying antirheumatic drugs (DMARDs), which can also help manage the disease to slow its progression and prevent joint damage. In general, treatment for rheumatoid arthritis focuses on managing the disease by preserving mobility and function, pain reduction, and preventing joint damage, and includes other medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and biological agents. Patients may additionally be prescribed physical therapy (PT) and/or occupational therapy and exercise, while some patients with more progressed rheumatoid arthritis may need surgery to repair or replace damaged joints, such as synovectomy (removal of joint lining), tendon repair, joint fusion, or total joint replacement. Medications – The types of medications prescribed for rheumatoid arthritis depend on the symptoms, how far the disease has progressed, and include the following medications: Non-steroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen (Advil or Motrin IB), naproxen sodium (Aleve), and celecoxib (Celebrex) may be used to relieve the pain and decrease inflammation associated with rheumatic arthritis. Other pain relievers, such as acetaminophen (Tylenol) or tramadol (Ultram), may also be used. Steroids – Corticosteroids, such as prednisone, help decrease pain, inflammation, and slow joint damage. Disease-modifying antirheumatic drugs (DMARDs) – These drugs can help prevent permanent joint and other tissue damage as well as can slow the progression of rheumatoid arthritis and include the medications methotrexate (Trexall and Otrexup), hydroxychloroquine (Plaquenil), leflunomide (Arava), and sulfasalazine (Azulfidine).  Other types of disease-modifying antirheumatic drug known as Janus kinase (JAK inhibitors, such as tofacitinib (Xeljanz) or baractinib (Olumiant), may also be used. Biologic agents – Biologic agents are a newer class of disease-modifying antirheumatic drugs (DMARDs) that target areas in the immune system that cause inflammation and joint and tissue damage, and are also known as biologic response modifiers, and include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret, certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara), and tocilizumab (Actemra). Physical and/or Occupational Therapy and Exercise – A physical or occupational therapist can provide exercises and methods for daily living that can help preserve joint mobility, in addition to assistive devices, such as tools with large hand grips, to protect joints. Regular walking and low-impact exercises can also help decrease pressure on joints. Surgery – Later stage rheumatoid arthritis that has progressed to severe joint damage or deformity may need surgery to repair or replace joints and/or to improve function and reduce pain. Surgeries for rheumatoid arthritis may include the following: Synovectomy – This surgery removes the lining of joint (synovium) that is inflamed, such as on the fingers, wrists, elbows, and hips. Tendon repair – Rheumatoid arthritis may cause tendon loosening or ruptures around joints and require tendon repair. Joint fusion – Joint fusion is when a joint is made immobile via surgery to provide stability or realignment as well as pain relief. Total joint replacement – Total joint replacement (arthroplasty) is when the damaged joint is removed and an implant (prosthesis) replaces the joint. Splints, braces, slings, orthotics, or Ace bandages – Any of these can be worn to take the pressure off joints and protect them.

There are online, local, national, and international support groups available for rheumatoid arthritis, and include the following: Arthritis Foundation - https://www.arthritis.org/ Rheumatoid Arthritis Support Network - https://www.rheumatoidarthritis.org/ra/types/

Rheumatoid arthritis is a chronic progressive disease characterized by flare ups and periods of remissions; however, patients who are treated early are often able to lead an active life, while avoiding severe joint damage or deformity.

Possible complications of rheumatoid arthritis may include the development of rheumatoid nodules (firm bumps) anywhere in the body, dry eyes and mouth (Sjogren’s syndrome), carpal tunnel syndrome (compressed nerve in wrist), osteoporosis (bone-thinning), leading to increased risk of fractures (broken bones), abnormal body composition (higher proportion of fat to lean mass; obesity), increased infections, heart and/or lung disease, lymphoma (blood cancer), and physical disabilities.

If you experience any joint pain or stiffness, especially in the morning, that lasts more than 30 minutes, or redness or swelling of the joints in fingers, wrists, elbows, shoulders, feet, ankles, knees, and hips, or any of these symptoms combined with fatigue or unexplained fever, contact your doctor as soon as possible.

While rheumatoid arthritis cannot be prevented, researchers have identified smoking as an increased risk factor for developing the disease; therefore, quitting smoking is advised. Researchers have further identified that women who have breastfed their babies have a decreased risk for developing rheumatoid arthritis.