Rheumatoid Arthritis Symptoms, Causes & Treatment Options

Rheumatoid arthritis (RA) is a chronic, autoimmune disease, meaning that the body's immune system mistakenly begins attacking the body's tissues and joint linings

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. Real-life Stories
  6. When to Seek Further Consultation
  7. Questions Your Doctor May Ask
  8. References

What Is Rheumatoid Arthritis?

Summary

Arthritis is a general term for multiple conditions that cause painful inflammation and stiffness throughout the body. Rheumatoid arthritis (RA) is a chronic condition that is autoimmune in nature, meaning that the body's immune system which normally protects the body by attacking foreign pathogens mistakenly begins attacking the own body's tissues. In adults, RA is the most common form of inflammatory arthritis caused by autoimmunity [1].

RA is caused by the immune system attacking the lining of the joints (synovium). This immune activity results in inflammation in the synovium that causes it to thicken and expand. The thickening destroys the cartilage and bone of the joint and causes the tendons and ligaments of the joint to weaken and stretch [2].

Over time, the cartilage loss continues, the space between bones becomes smaller, and eventually the joint becomes loose, painful and unstable. As the condition becomes more advanced, RA can also affect multiple organ systems, including the eyes, skin, lungs and the cardiovascular system.

Diagnosis is through physical examination, blood tests, and X-rays. Treatments include lifestyle modifications, several classes of medications, and sometimes surgery [3].

Recommended care

You should visit your primary care physician who will coordinate care with a specialist. RA is a complex disease, which can require prescription medication to help slow down the damage to your joints, as well as pain killers such as ibuprofen (Advil), or naproxen (Anaprox and Naprosyn). Exercise, especially swimming, can also help with pain and stiffness.

Rheumatoid Arthritis Symptoms

In the beginning, symptoms are most common in the smaller joints, such as the finger and toe joints. However, as the disease progresses, the symptoms spread to the larger joints, such as the knees, ankles, hips and shoulders. Signs and symptoms of RA include:

  • Fatigue
  • Fever
  • Weight loss
  • Joint pain, tenderness or swelling: This must persist for 6 weeks or longer.
  • Symmetric joint involvement: Meaning the same joints on both sides are affected
  • Morning stiffness: Meaning stiffness is worse in the morning, lasts at least 15 minutes, and improves throughout the day

Complications

Approximately 40 percent of people with RA develop complications [4]. Complications that may occur in addition to the joint damage caused by RA include:

  • Heart problems: RA increases the risk of heart problems due to inflammation that can harden and block arteries and surround the heart.
  • Rheumatoid nodules: These are firm bumps of tissue most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the lungs.
  • Lung disease: People with RA have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
  • Lymphoma: RA increases the risk of lymphoma, which is a group of blood cancers that develop in the lymph system.
  • Carpal tunnel syndrome: When RA affects the wrists, inflammation can compress the median nerve, which is the nerve responsible for sensation and movement in most of the hand and fingers.

Rheumatoid Arthritis Causes

Although the effects of RA are well described, the reason why the immune system attacks the synovium in the first place is not completely understood. RA has been confirmed to have more than 100 associated factors associated with development of the disease [5]. Some of those include:

  • Genetics: People with a specific genetic marker called the HLA shared epitope have a five times greater chance of developing RA than do people without the marker [6]. This and other genes that control immune response are related to RA; nevertheless, many people with RA do not have these genes, and vice versa. Having a family history of RA increases the odds of developing the condition; however, most people with RA do not have a family member with the condition.
  • Environment: Some studies have shown that exposure to asbestos or silica may increase the risk for developing RA, although this link is not fully understood. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as RA. Smoking and obesity can also modulate the progression of the disease [7].

  • Gender: RA is nearly three times more common in women than men. The exact reason for this gendered difference is not exactly known, but autoimmune conditions are usually more prevalent in women than men.

  • Age: RA most commonly begins between the ages of 30 and 60 in women, but in men often occurs later in life.

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Treatment Options and Prevention for Rheumatoid Arthritis

Joint and bone damage from RA cannot be reversed, but there are many treatment options available to help alleviate symptoms and control progression of disease especially if the condition is identified and diagnosed early [8].

Medications

Medications given for RA range from over-the-counter pain relievers that you can buy at a pharmacy or grocery store to injections or infusions of serious medications available only with a prescription.

  • Pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), or celecoxib (Celebrex) are often used to help manage pain symptoms of RA.
  • Steroids: These help combat and reduce inflammation.
  • Disease-modifying anti-rheumatic drugs (DMARDs): Such as sulfasalazine (Azulfidine), methotrexate, hydroxychloroquine (Plaquenil) and leflunomide (Arava) help control symptoms and reduce joint damage [9]. Many of these RA medications must be stopped prior to pregnancy.
  • Biologic Response Modifiers (biologics): These are a newer class of RA treatment. These medications, such as adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), and tofacitinib (Xeljanz), among others, may be prescribed if DMARDs don't work for you.

Physical therapy

Your physician may prescribe stretching exercises or a physical therapy/rehabilitation program to help you maintain flexibility and use of your joints. Your physical therapist will not only be able to suggest stretches and exercises but will also be able to provide assistive devices that can make put less stress on your joints. For example, a kitchen knife with a saw handle can help protect the fingers and wrists.

Surgery

If medications fail to prevent or slow joint damage, you and your physician may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities.

Lifestyle modifications

Beyond medications and treatments offered by your physician, there are several things you can do at home to improve your RA and reduce associated complications:

  • Stop smoking if you do
  • Sleep habits: Make sleep a priority. Shut down anything with a screen one hour before you want to fall asleep.
  • Exercise: Be sure to get regular exercise, even if only 30 minutes four times per week. Make sure the exercise is gentle on your joints (swimming, yoga) but still gets your heart pumping and strengthens your muscles.
  • Nutrition: Always choose healthy foods that provide good nutrition over packaged and processed foods that are high in sugar and low in nutrients.

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When to Seek Further Consultation for Rheumatoid Arthritis

If you experience symptoms, such as tender and swollen joints, morning stiffness, fever and fatigue, make an appointment with your physician. Achy bones and joints should not be brushed off as an inevitable development of aging. The earlier RA is diagnosed, the better the outcome.

Questions Your Doctor May Ask to Determine Rheumatoid Arthritis

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Do you have trouble sleeping?
  • Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
  • Have you lost your appetite recently?
  • Do you currently smoke?
  • Any fever today or during the last week?

If you've answered yes to one or more of these questions

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References

  1. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part I. Arthritis Rheum. 2008;58:1525. PubMed Link
  2. Matteson EL, et al. Overview of the systemic and nonarticular manifestations of rheumatoid arthritis. UptoDate. Accessed Aug. 21, 2018. UpToDate Link.
  3. Singh JA, Saag KG, Bridges Jr. SL, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research, 2015. DOI 10.1002/acr.22783. Retrieved from Rheumatology PDF Link
  4. Turesson C, O'Fallon WM, Crowson CS, et al. Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62:722. BMJ Link.
  5. Okada Y, Wu D, Trynka G, et al. Genetics of rheumatoid arthritis contributes to biology and drug discovery. Nature. 2014;506:376. Nature Link.
  6. de Vries N, Tijssen H, van Riel PL, van de Putte LB. Reshaping the shared epitope hypothesis: HLA-associated risk for rheumatoid arthritis is encoded by amino acid substitutions at positions 67-74 of the HLA-DRB1 molecule. Arthritis Rheum. 2002; 46:921. PubMed Link
  7. Arthritis Foundation. Rheumatoid Arthritis Causes, 2018. Arthritis Foundation Link.
  8. Smolen JS, Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631. BMJ Link
  9. Singh JA, Furst DE, Bharat A, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64:625. PubMed Link

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