Rheumatoid arthritis is an autoimmune disease that causes the immune system to mistakenly attack the joints. This creates inflammation and leads to a thickening of the synovium, which is the tissue that lines the inside of the joints that is responsible for lubricating them and facilitating smooth movement. This inflammation and thickening ultimately leads to pain and swelling around the joints.
Around 1.5 million people in the US have rheumatoid arthritis, and the condition affects nearly three times as many women as men. In women, rheumatoid arthritis tends to show up between the ages of 30 and 60, while men usually start having symptoms later in life. Family history can play a role in rheumatoid arthritis, but the majority of people with the condition have no family members with it.
If left untreated, rheumatoid arthritis can damage cartilage and lead to more narrow spacing between the bones of the joint, which causes the joints to become loose, unstable and painful. Joint deformity may occur, and the damage cannot be reversed. As such, doctors recommend early, aggressive interventions for rheumatoid arthritis, so it’s important for you to know how to recognize this condition and what to expect from treatment.
Signs and Symptoms of Rheumatoid Arthritis
Most commonly, rheumatoid arthritis affects the feet, hands, wrists, elbows, knees and ankles, and in general the effect is symmetrical. If one knee is affected, usually the other is as well. In some cases, rheumatoid arthritis can affected entire body systems, such as the cardiovascular or respiratory system. This is called “systemic disease.”
The following joint symptoms are indicative of rheumatoid arthritis:
- Pain, tenderness, swelling or stiffness in the joints that persists for six weeks or longer
- Joint stiffness in the morning that lasts for 30 minutes or longer
- Experiencing the above-listed symptoms in more than one joint
- Redness around the affected joint or joints
Beyond these joint-specific symptoms, people with rheumatoid arthritis may experience fatigue, loss of appetite and weight loss. Prolonged inflammation can also have an effect on other parts of the body:
Mouth. Gum irritation, dryness or infection
Skin. Small lumps under the skin over bony areas, called rheumatoid nodules
Lungs. Inflammation and scarring that could lead to shortness of breath
Eyes. Redness, pain, dryness, impaired vision and sensitivity to light
Blood vessels. Inflammation of blood vessels can lead to damage in the nerves, skin and other important organs.
Blood. Inflammation can lead to a low red blood cell count, called anemia.
Diagnosing Rheumatoid Arthritis
Your doctor may suspect rheumatoid arthritis based on your signs and symptoms, although there is no one blood of physical test that definitively confirm a rheumatoid arthritis diagnosis. Prior to performing testing the doctor will check the joints for redness, swelling and warmth.
Blood testing. People with rheumatoid arthritis typically have elevated levels of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). These could indicate inflammation in the body. Other blood tests that can be used to investigate a possible rheumatoid arthritis diagnosis include tests to identify rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
Imaging tests. X-ray images can help to determine whether or not there’s narrowing space between your joints, which would indicate loss of cartilage. Meanwhile, magnetic resonance imaging (MRI) testing can produce detailed images of bone, cartilage and other soft tissues by using radio waves and a strong magnetic field.
Treatment for Rheumatoid Arthritis
There is no cure for rheumatoid arthritis, but advancements in treatment techniques have made the condition very manageable for people.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as products with ibuprofen and naproxen sodium, can help to alleviate pain associated with osteoarthritis. Topical NSAIDs can also be effective. In more extreme cases, the doctor may prescribe prescription-grade NSAIDs to help reduce the inflammation.
Disease-modifying antirheumatic drugs (DMARDs). DMARDs can help to slow down rheumatoid arthritis progression to work toward sparing other joints and tissues from permanent damage. Medications with methotrexate, leflunomide, hydroxychloroquine and sulfazine are common DMARDs.
Biologic response modifiers. Biologic agents are a new class of DMARDs that target the part of the immune system that control inflammation. Newer biologic medications include abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), tocilizumab (Actemra) and tofacitinib (Xeljanz).
Steroids. Corticosteroid medications can help to reduce inflammation and pain while also slowing down the progression of joint damage. Your doctor may prescribe a steroid to address your acute symptoms while tapering you off your other medications.
Physical therapy. Physical therapists can help create an exercise and stretching plan tailored to your individual needs. These exercises are geared toward strengthening the muscles around the affected joint to increase range of motion and lower pain levels.
Occupational therapy. Occupational therapists can assist you in learning how to do the everyday tasks you need to do without exacerbating rheumatoid arthritis symptoms..
Calming movement therapies. Movement therapies like tai chi and yoga can help reduce the stress in your life while stretching and breathing deeply. These therapies can also help to loosen you up a bit help reduce the pain associated with rheumatoid arthritis.
When medication and other conservative treatments fail to bring relief for rheumatoid arthritis pain, your doctor may recommend surgical intervention to restore your ability to use your joint. Rheumatoid arthritis surgery can involve any of the following procedures:
Tendon repair. Joint damage and inflammation can cause tendons around the joint to loosen or rupture. Surgery can repair this damage.
Synovectomy. Surgery can remove the inflamed synovium around the elbows, knees, fingers, wrists and hips.
Joint replacement. In the most extreme cases, a joint replacement (arthroscopy), can be performed to remove the damaged joint surfaces. The doctor can then place them with plastic or metal parts.
Joint fusion. When joint replacement isn’t an option, your doctor may recommend a fusion to stabilize or realign a joint for pain relief.