What Is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that causes pain, swelling, and inflammation in the joints when the immune system begins to attack healthy tissue. The specific causes of RA are currently unknown. Unlike other types of arthritis which typically occur as people age, RA can affect people at any age.

In the early stages of RA, you may experience symptoms in your hands, wrists, or feet. If your condition progresses, inflammation can also spread to larger joints in the body, such as the knees and hips. Fatigue is also common, as joint pain and swelling can make you feel tired and weak.

There's no known cure for RA. But, some treatments can prevent your condition from progressing, relieve symptoms, and improve your overall quality of life. That's why early diagnosis and treatment are so important.

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Types

Not all cases of RA look the same. Naturally, scientists want to know what's causes differences in symptoms, disease progression, and outcomes. 

As research on RA is ongoing, scientists have identified two factor that can help distinguish different types of RA. Their findings so far: certain proteins in your blood attack your body. These proteins are called rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCPs). Anti-CCPS are also referred to as anti-citrullinated protein antibodies (ACPAs). Blood tests can determine if you have either of these proteins.

You might hear healthcare providers talk about different types of rheumatoid arthritis, which include:

• Seropositive RA: Your blood has a positive RF or anti-CCPs. Seropositive RA is the most severe form of RA and accounts for the most cases. If this condition progresses, people with type of RA can experience joint damage, rheumatoid nodules (bumps under the skin), and vasculitis (inflamed blood vessels).
• Seronegative RA: Your blood has negative RF or does not have anti-CCPs. But, you still experience the painful symptoms of RA, such as joint pain, stiffness, and swelling. Seronegative RA is less severe and less common than seropositive RA.
• Juvenile RA: Also called juvenile idiopathic arthritis (JIA), this type of RA only affects children younger than 16. In addition to joint pain, children with JIA can also experience fever or rash. With proper treatment, symptoms tend to ease.

Symptoms

Some people with RA may see their symptoms develop slowly, while others experience a rapid disease onset. The most common signs and symptoms of RA include:

• Painful aching in the joints
• Stiff, tender, or swollen joints, especially in the morning
• Feeling joint pain on both sides of the body
• Low-grade fever
• Unintentional weight loss or loss of appetite
• Fatigue or weakness
• Trouble falling or staying asleep
• Injuries that take a long time to heal
• Foot pain
• Numbness or tingling in the hands
• Eye or vision problems

While RA typically affects the joints, if your condition progresses, you may experience complications that affect the heart, lungs, blood, nerves, eyes, and skin. Sjögren's syndrome, an autoimmune condition causing dry eyes and mouth, may also occur. The good news is that treatment can slow down the disease from progressing and limit how much the condition affects your daily life.

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Causes

When you have RA, your immune system doesn't function as it should and attacks healthy cells, which causes inflammation and painful swelling in your joints. While the exact cause of RA is still being researched, a combination of genetic and environmental factors can help explain why you might start to experience symptoms.

Here's a quick breakdown of how scientists believe RA develops:

• You might have inherited a certain gene, like the HLA-DBR1, which is associated with RA.
• If you have a gene that is linked to RA, your immune system can attack healthy cells in your body.
• Once your immune system attacks your body, you can start to experience pain and inflammation.
  
• Inflammation can then spread to the inner lining of the joints, which is called the synovium.
• Too much inflammation in the synovium can make the joint lining thick.
• The thick synovium can irritate the joint, causing pain and damage to the cartilage and bones.
• The damage to your joints may later affect nearby muscles, ligaments, and tendons. 

Some people may also be more likely to develop RA than others. Risk factors that might increase your risk of developing RA include:

• Age: Some children may develop juvenile RA, but your risk of developing chronic seropositive or seronegative RA increases as you age. 
• Sex: Women are two to three times more likely to develop RA than men. Some evidence suggests that the hormone estrogen may trigger RA.
• Genetics: You are more likely to develop RA if you have family members who also have the condition.
• Smoking: Long-term tobacco use boosts your risk of developing RA.
• Weight: Obesity may increase your risk of developing the condition.
• Stress: Emotional or physical stress may lead to a faster onset of RA, if you have a family history of the disease.
  
• Illness or infection: Some infections, like human immunodeficiency virus (HIV) or hepatitis are linked to a higher risk of developing RA.
• Environmental toxins: Mines, quarries, and steel mills may expose you to silica. Silica is an environmental toxin that can increase your risk of getting RA.

Diagnosis

Generally, RA can be difficult to diagnose because it can take a long time for the condition to become apparent. Symptoms also tend to vary from person to person. At times, RA symptoms can mimic other joint disorders and make it hard to tell which type of arthritis you have.

No single test can confirm a diagnosis of RA. The quest for answers usually begins with your healthcare provider conducting a physical exam and asking about your family medical history. Your provider may then order blood tests that look for inflammation and antibodies.

In some cases, you may be asked to take an imaging test, like an X-ray. While imaging tests don't always detect early changes to your joints and bones, they can provide a baseline for keeping track of how RA progresses.

Physical Exam

Your healthcare provider can assess your joints with a physical exam. They may ask you to walk around or bend your joints to examine their strength. 

Your provider may also look for other signs and symptoms of the disease, such as a rash. They may also listen to your chest using a stethoscope to hear if there is any signs of inflammation in your lungs.

Medical History

Your medical history can help determine your risk of developing RA. Your healthcare provider may ask about your family history, your general health, and your lifestyle. During this time, they may also ask you about the severity of your symptoms and how long you have been experiencing joint pain or swelling.

Blood Tests

To get a better sense of your condition, your healthcare provider can order a blood test to check the counts of different types of antibodies and proteins. Some specific blood tests may examine:

• Anti-CCP: These are the antibodies that indicate whether you have seropositive or seronegative RA. In some cases, anti-CCP may appear in your blood before you notice symptoms. If a blood test detects anti-CCP, your provider may be able to diagnose and treat RA early.
• Rheumatoid factor (RF): RF is another type of antibody that may present in people with RA. 
• Erythrocyte sedimentation rate (sed rate): A test that measures inflammation in your body.
• C-reactive protein: Similar to the sed rate, this test can also detect inflammation. 
  

Imaging Tests

X-rays, magnetic resonance imaging (MRI), and ultrasounds can help diagnose RA. But if your RA is in the early stages, it may be hard for those tests to detect any changes or joint damage. Physical exams, medical history review, and blood tests are typically the most reliable diagnostic tools.

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Treatment

If your healthcare provider diagnoses you with RA, your care team will likely include a rheumatologist, or a who specializes in joints, muscles, and bones. Your care team will work with you to find a treatment plan that is best for you.

Treatments can help slow down the progression of RA and prevent serious joint damage. Typically, treatments will include a combination of medication, self-care strategies, and therapy. As with many other chronic conditions, the sooner you begin treatment, the better.

Medication

RA is progressive, but you can manage it with medications. Your healthcare provider may prescribe any of the following remedies:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or aspirin
• COX-2 inhibitors, such as Celebrex
• Corticosteroids, like prednisone
• Disease-modifying antirheumatic drugs (DMARDs), which including methotrexate and hydroxychloroquine
• Biologics, such as Enbrel (etanercept) and Remicade (infliximab)
  

Self-Care Strategies

Your care team may also recommend making lifestyle changes to protect your joints and alleviate pain, such as:

• Physical activity: Some evidence suggests regular exercise strengthens your joints and prevents further damage. Generally, 30 minutes of exercise per day can be beneficial.
• Weight management: Obesity increases your risk of developing RA and can worsen symptoms. Maintaining a weight that is right for you can help decrease pressure and pain on your joints.
• Regular check-ups: Communicate with your care team to update them about your symptoms or progress. These check-ins can help them make any changes to your treatment, if necessary.
• Physical stress reduction: Avoid work or activities that worsen pressure on your joints. You may find it helpful to ask loved ones to help you with tasks such as carrying groceries or lifting heavy objects.
• Hot and cold compresses: Using alternative hot and cold treatments, such as a heating pad and ice, can help reduce joint pain and swelling. Be sure to use each treatment for no more than 15 minutes at a time to lower the risk of getting burns or frostbite.
• Physical and occupational therapy: A physical therapist can help you learn exercises and massage techniques that can ease symptoms and make your joints more mobile. An occupational therapist can teach you how to do daily activities such as getting dressed or cooking and help you pick out assistive devices, like a walking cane.

If medication and self-care strategies aren't improving your condition, your care team may recommend surgery. Generally, surgery is a last resort option and your providers may try new medications or suggest seeing other specialists (e.g., a physical therapist) before surgery.

Prevention of RA Flare-Ups

Some people with RA experience flare-ups after periods of remission. These flare-ups can sometimes be unpredictable. However, there are a few ways to prevent flare-ups from occurring, such as:

• Reducing emotional stress
• Not overexerting yourself
• Getting good sleep
• Limiting alcohol and tobacco use
• Taking your medication(s) on time
  

Living With Rheumatoid Arthritis

The painful symptoms of RA make it hard to complete daily activities. You can help minimize pain through the following strategies:

• Gentle movement and low-impact exercise, such as walking or yoga
• Breaks throughout the day and a good night's sleep
• Assistive devices, such as canes or walkers, to decrease the stress on your joints
• A healthy weight
• Heat (like hot showers or baths) to relax muscles
• Cold (like ice packs) to ease pain and swelling
• Topical creams or gels for pain relief
• Meditation, deep breathing, and massages
• An omega-3 fatty acid supplement
• Social and emotional support from your loved ones

Living with RA is not only painful, but can make you feel frustrated and isolated, too. If these self-care strategies don't seem to be working, talk to your care team about other recommendations that can help you manage your condition. In some cases, you may also find it helpful to ask for a referral to a mental health professional for additional support.

A Quick Review

RA is an autoimmune disease that occurs when your immune system attacks healthy tissue in your joints and causes inflammation and pain.

Currently, researchers don't know exactly why RA occurs. Genetic, environmental, and lifestyle factors—like having a family history of RA or smoking—may increase your risk of developing this condition.

Although there is not cure for RA currently, medications and self-care strategies can help you manage your condition, prevent flare-ups, and slow down or stop joint damage. Consult your healthcare provider if you have symptoms of RA or may be at risk for developing the condition. Early diagnosis and treatment of RA can help prevent severe pain and improve your overall quality of life.