What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disease—a type of illness where the immune system attacks healthy cells by mistake. If you have RA, your immune system can target and destroy the healthy tissues that cover your joints.
RA is a type of arthritis that can cause inflammation of the lining of your joints, also known as synovitis. When the coverings of your joints are inflamed, you may feel pain, swelling, redness, or warmth to the touch. If not treated, this inflammation may lead to joint damage and arthritis.
Joints are the main target of RA. However, other organs such as the eyes, heart, lungs, skin, and blood vessels can also be affected. This may occur if the body’s immune system attacks these organs in the same way it attacks joints. It’s important to treat the RA to reduce your symptoms and prevent long-term damage to your joints.
Most common symptoms
Rheumatoid arthritis can involve multiple joints—osteoarthritis typically affects only 1 to 3 joints. —Dr. Benjamin Schwartz
People with RA have painful, stiff, and swollen joints. Your joints become inflamed and larger, and they may begin to feel what doctors call boggy, which means your joints feel mushy when you touch them.
The disease can involve just a few joints or many. Hands are usually the most affected. But just about any joint can be damaged by RA.
Symptoms can differ from one person to the next. Some people may live with constant symptoms. But for others, symptoms may come and go.
- Pain, swelling, and stiffness in the joints
- Warmth and redness of the joints
- Deformed joints (in severe, untreated cases)
Other symptoms you may have
- Low energy
- Muscle aches
- Loss of appetite
The first step for treating joint pain and swelling is resting your joints, applying ice, and taking anti-inflammatory medication. If joint pain and swelling last for more than a few weeks, even with these treatments, call your doctor.
Because RA symptoms can be very different for each person and blood tests for the disease can be inconclusive, diagnosis can be tricky. Your doctor may refer you to a rheumatologist (an arthritis specialist).
There is no one blood test that confirms RA. However, blood tests can rule out other conditions. Since RA is an inflammatory disease, a test can find higher levels of markers in your blood that may indicate inflammation. A rheumatoid factor (RF) blood test can also help confirm the diagnosis. X-rays may be helpful to see how much joint damage there is.
If RA is not treated, you may have permanent damage in your joints.
Treatment of rheumatoid arthritis
A new class of medications called “biologics” have greatly improved our ability to minimize the effects of RA on the body. These medications, typically given as a monthly infusion, have been game changers in preventing the destruction of joints that used to be a hallmark of RA. —Dr. Schwartz
There is no known cure for RA. But there are many effective treatments to ease your pain and other symptoms. The decision on when to start medications and which medications are most appropriate will depend on discussions with your doctor and how bad your symptoms are. When severe joint deformity occurs, replacement surgery may become necessary.
- NSAIDs: Over-the-counter medications such as ibuprofen (Motrin, Advil) and naproxen (Aleve) can relieve pain by reducing joint inflammation. NSAIDs work best if taken consistently. But they can cause stomach irritation, liver, or kidney problems so you should talk with your doctor about your risks before starting.
- Disease-modifying antirheumatic drugs (DMARDs): These prescription medications work by reducing the damage done to the joints by rheumatoid arthritis. Common DMARDs include methotrexate, hydroxychloroquine (Plaquenil), and sulfasalazine. Potential side effects include liver damage and bone marrow suppression.
- Biologic agents: These are a newer class of medications that limit the immune system’s ability to damage the joints. Many biologic agents have become available in recent years, including adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel). Because these drugs alter your immune system, they can increase the risk of infections.
- Cortisone injections: Cortisone is a type of anti-inflammatory medication that acts within the joint. These injections are typically performed in the doctor’s office by a rheumatologist or orthopedic surgeon.
- Joint replacement surgery: In cases where damage is severe, joint replacement surgery may be required. Damaged cartilage and bone are removed and replaced with metal and plastic parts. However, RA patients may be at increased risk of surgical complications.
What is the main cause of rheumatoid arthritis?
Rheumatoid arthritis occurs when the body’s immune system attacks the joints. For reasons that are not well understood, the body sends a signal to the immune system to attack the lining of the joints (synovium). That makes the lining inflamed and thickened. This inflammation and thickening causes the joints to become stiff, warm, painful, and swollen.
If RA is not treated, you can have permanent damage to the joints and the cartilage can break down.
What makes you more likely to have rheumatoid arthritis?
While rheumatoid arthritis can affect just about anyone, it is seen most commonly in women over the age of 50. Early signs can be subtle, including unexplained fatigue, dry eyes and/or mouth, and mild stiffness of the joints. —Dr. Schwartz
No one knows what causes rheumatoid arthritis. However, it may have to do with genetics, exposure to certain types of infections, or other environmental factors.
- Having a family history of rheumatoid arthritis or exposure to certain viruses or bacteria can be risk factors.
- Smokers are more likely to develop RA than non-smokers.
- Gender may also play a role. Women are 2 to 3 times more likely than men to have RA. Also, the diagnosis tends to occur in middle age—the period between early adulthood and old age.
If you don’t treat your RA, your joints and cartilage (the connective tissue between your joints) can be permanently damaged. If your symptoms are mild, you only need to follow up with your doctor if pain gets worse or your joints become severely swollen and stiff.
If RA has begun to damage your joints or the disease is affecting other parts of your body, you may require more care from your doctor.
No one knows the exact causes of RA. So there isn’t any way to prevent it. The goal is to get treatment to minimize symptoms.
Taking medications can help make flare-ups shorter and less painful. Follow up with your primary doctor or rheumatologist to manage the disease and keep symptoms under control.
Dr. Schwartz is a board-certified Orthopedic Surgeon and Member of the Buoy Medical Advisory Board. He graduated Magna Cum Laude from the College of William and Mary (1998) with a B.S. in Biology, then obtained his medical degree from the Medical College of Virginia (2002) where he was elected to the Alpha Omega Alpha Medical Honor Society. After completing his Orthopedic Surgery Residency at Boston Medical Center (2007), Dr. Schwartz performed a fellowship in Adult Reconstruction at the Anderson Orthopedic Clinic in Alexandria, VA (2008). As a private practice surgeon, Dr. Schwartz specializes in the treatment of hip and knee arthritis including joint replacement surgery.
On a national level Dr. Schwartz serves several leadership positions including as an Editorial Board Member of the Journal of Arthroplasty, a member of the Practice Management Committee of the American Association of Hip and Knee Surgeons, and a member of the Hip and Knee Content Committee for the American Academy of Orthopedic Surgeons. With a keen interest in healthcare technology, Dr. Schwartz has served as a mentor for several digital health incubators and as an advisor for health tech startups. He joined Buoy as a content writer in 2019 and became a member of the Medical Advisory Board in 2020.