Arthritic Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.
The disease may also affect other parts of the body. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.
While the cause of rheumatoid arthritis is not clear, it is believed to involve a combination of genetic and environmental factors. The underlying mechanism involves the body’s immune system attacking the joints. This results in inflammation and thickening of the joint capsule. It also affects the underlying bone and cartilage.
The diagnosis is made mostly on the basis of a person’s signs and symptoms. X-rays and laboratory testing may support a diagnosis or exclude other diseases with similar symptoms. Other diseases that may present similarly include systemic lupus erythematosus, psoriatic arthritis, and fibromyalgia among others.
The goals of treatment are to reduce pain, decrease inflammation, and improve a person’s overall functioning. This may be helped by balancing rest and exercise, the use of splints and braces, or the use of assistive devices. Pain medications, steroids, and NSAIDs are frequently used to help with symptoms.
Disease-modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine and methotrexate, may be used to try to slow the progression of disease. Biological DMARDs may be used when disease does not respond to other treatments. However, they may have a greater rate of adverse effects. Surgery to repair, replace, or fuse joints may help in certain situations. Most alternative medicine treatments are not supported by evidence.
RA affects about 24.5 million people as of 2015. This is between 0.5 and 1% of adults in the developed world with 5 and 50 per 100,000 people newly developing the condition each year. Onset is most frequent during middle age and women are affected 2.5 times as frequently as men.
In 2013, it resulted in 38,000 deaths up from 28,000 deaths in 1990. The first recognized description of RA was made in 1800 by Dr. Augustin Jacob Landré-Beauvais (1772–1840) of Paris. The term rheumatoid arthritis is based on the Greek for watery and inflamed joints.
Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system – which normally protects its health by attacking foreign substances like bacteria and viruses mistakenly attacks the joints. This creates inflammation that causes the tissue that lines the inside of joints (the synovium) to thicken, resulting in swelling and pain in and around the joints. The synovium makes a fluid that lubricates joints and helps them move smoothly.
If inflammation goes unchecked, it can damage cartilage, the elastic tissue that covers the ends of bones in a joint, as well as the bones themselves. Over time, there is loss of cartilage, and the joint spacing between bones can become smaller. Joints can become loose, unstable, painful and lose their mobility. Joint deformity also can occur. Joint damage cannot be reversed, and because it can occur early, doctors recommend early diagnosis and aggressive treatment to control RA.
Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. The joint effect is usually symmetrical. That means if one knee or hand if affected, usually the other one is, too. Because RA also can affect body systems, such as the cardiovascular or respiratory systems, it is called a systemic disease. Systemic means “entire body.”
Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.
An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body’s tissues.
Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.
Rheumatoid arthritis (RA) is an autoimmune disease that can cause joint pain and damage throughout your body. The joint damage that RA causes usually happens on both sides of your body. So if a joint is affected in one of your arms or legs, the same joint in the other arm or leg will probably be affected, too. This is one way that doctors distinguish RA from other forms of arthritis, such as osteoarthritis (OA).
Treatments work best when RA is diagnosed early, so it’s important to learn the signs. Read on to learn everything you want to know about RA, from types and symptoms, to home remedies, diets, and other treatments.
Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints.
It’s 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 distal joints symmetrically, for example, the hands, wrists, and knees.
About 1 percent of the American population lives with rheumatoid arthritis. According to a 2017 report in the journal Rheumatoid International, the prevalence of RA in the United States increased between 2004 and 2014, affecting about 1.3 million adults in 2014.
Two to three times as many women as men develop RA, and 70 percent of people with RA are women, according to the Arthritis Foundation.
RA primarily affects joints, but it also affects other organs in more than 15–25% of individuals.
Signs and symptoms of rheumatoid arthritis may include:
- Tender, warm, swollen joints
- Joint stiffness that is usually worse in the mornings and after inactivity
- Fatigue, fever and weight loss
Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.
As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.
About 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don’t involve the joints.
Rheumatoid arthritis can affect many non joint structures, including:
- Salivary glands
- Nerve tissue
- Bone marrow
- Blood vessels
Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place
RA is a long-term or chronic disease marked by symptoms of inflammation and pain in the joints. These symptoms and signs occur during periods known as flares. Other times are known as periods of remission this is when symptoms dissipate completely.
RA symptoms, which can occur throughout the body, include:
- joint pain
- joint swelling
- joint stiffness
- loss of joint function
Symptoms can vary from mild to severe. It’s important not to ignore your symptoms, even if they come and go. Knowing the early signs of RA will help you and your doctor to better treat it.
Rheumatoid arthritis is a complex disease that is not well understood by medical practitioners or researchers. Early signs of disease, such as joint swelling, joint pain, and joint stiffness, typically begins 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 and wrists.
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.
Rheumatoid arthritis occurs when your immune system attacks the synovium the lining of the membranes that surround your joints.
The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint.
The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.
Doctors don’t know what starts this process, although a genetic component appears likely. While your genes don’t actually cause rheumatoid arthritis, they can make you more susceptible to environmental factors such as infection with certain viruses and bacteria that may trigger the disease.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
Researchers don’t know exactly what causes the immune system to invade the synovium, though it’s believed that genes and environmental factors play a role in the development of RA.
Research suggests that people with certain genetics, the human leukocyte antigen (HLA) genes, have an up to fivefold increased risk of developing RA. The HLA gene complex controls immune responses by producing proteins that help the immune system recognize proteins from foreign invaders.
Other genes connected to RA include some involved with the immune system and inflammation, such as STAT4, TRAF1, C5, and PTPN22.
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)
- Female hormones
- Exposure to certain kinds of dust and fibers
- Severely stressful events (2, 3, 4, 7, 8)
Equally important are smoking and a family history of RA in increasing a person’s risk of developing the condition.
Diagnosing RA can take time and may require multiple lab tests to confirm clinical examination findings. Your doctor will use several tools to diagnose RA.
First your doctor will ask about your symptoms and medical history. They’ll also perform a physical exam of your joints. This will include looking for swelling and redness, and testing your reflexes and muscle strength. Your doctor will also touch the affected joints to check for warmth and tenderness. If they suspect RA, they’ll most likely refer you to a specialist called a rheumatologist.
Since no single test can confirm a diagnosis of RA, your doctor or rheumatologist may use several different types of tests. They may test your blood for certain substances like antibodies, or check the level of certain substances like acute phase reactants that are elevated during inflammatory conditions. These can be a sign of RA and help support the diagnosis.
They may also request certain imaging tests. Tests such as ultrasonography, x-ray exams, and magnetic resonance imaging (MRI) not only show if damage from RA has been done to your joints but also how severe the damage is. A complete evaluation and monitoring of other organ systems might be in order for some people with RA, too. Learn more about the process of diagnosing RA.
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. After symptoms are discussed and evaluated, blood tests for rheumatoid factor and other antibodies are ordered. Imaging tests such as X-ray, ultrasound, and magnetic resonance imagery (MRI) scans may be used to help a doctor determine if your joints have been damaged, or to detect joint inflammation, erosion, and fluid buildup. Risk factors for rheumatoid arthritis include a personal history of smoking and a family history of RA.
There’s no cure for RA, but there are treatments that can help you to manage it. Treatments for RA help to manage the pain and control the inflammatory response which can in many cases result in remission. Decreasing the inflammation can also help to prevent further joint and organ damage.
Treatments may include:
- alternative or home remedies
- dietary changes
- specific types of exercise
Your doctor will work with you to determine the best types of treatments for you. For many people, these treatments can help them live an active life and reduce the risk of long-term complications. Learn more about specific RA treatments and how to treat flares.
There is no known cure for rheumatoid arthritis. To treat the condition, 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 preventing disability, and it usually amounts to treatment with anti-inflammatory drugs, and sometimes more than one medication at a time.
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