Health A-Z

An Overview of Rheumatoid Arthritis

An Overview of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disease that affects more than just your joints. Unlike osteoarthritis, which is caused by the long-term wear and tear of joint cartilage, rheumatoid arthritis is an autoimmune disorder in which the immune system attacks its own tissues and cells, including those of the joints, skin, eyes, heart, lungs, and nerves.

Over time, the persistent inflammation can lead to the progressive loss of mobility, pain, and joint deformity.

While scientists have yet to find a cure for rheumatoid arthritis, physiotherapy and newer biologic drugs are offering relief for the estimated 1.5 million Americans living with the disease.

Symptoms

Rheumatoid arthritis primarily affects the joints. The pattern and characteristics of the disease can vary from one person to the next. For some, the symptoms will strike suddenly and severely. For others, the signs can develop gradually, often starting with a dull achiness or stiffness in the smaller joints, particularly those of the fingers or toes, before becoming progressively worse.

Over time, others joints may become affected. The pattern of involvement tends to be symmetrical, meaning that symptoms occurring on one side of the body will usually be mirrored on the other side.

The common signs and symptoms of rheumatoid arthritis include:

  • Joint tenderness, warmth, swelling, and pain
  • Fatigue, low-grade fever, and weight loss
  • Morning stiffness lasting around an hour

As the disease progresses, joint tissues can become bonded together (tethered), resulting in a further loss of movement. The erosion of cartilage, ligaments, and bone can eventually cause the joint to entirely lose it alignment and shape, resulting in severe and sometimes unsightly joint deformity.

Other Affected Organs

The inflammation exerted by rheumatoid arthritis can adversely affect other organs as well, causing both localized and systemic (whole-body) symptoms. The most common of non-joint complications include:

  • Rheumatoid nodules, hardened lumps that form under the skin, most often around the elbows, heels, or knuckles
  • Pleuritis, the inflammation of the lining of the lungs, causing shortness of breath, rapid breathing, and a dry cough
  • Pericarditis, the inflammation of the membrane surrounding the heart, causing chest pain, chest tightness, and fatigue
  • Vasculitis, the inflammation of the blood vessels, causing fever, fatigue, weight loss, and muscle and joint pain
  • Scleritis, the inflammation of the white of the eye, causing redness, tearing, light sensitivity, and vision loss

Less commonly, other organs such as the kidneys, liver, bones, and nerve tissue may be affected.

Common signs of rheumatoid arthritis in the hand.

Causes

As with other autoimmune diseases, the exact cause of rheumatoid arthritis is unknown.

Statistically speaking, women are three times more likely to get the disease than man. The risk tends to increases with age, with the onset of symptoms generally occurring between the ages of 40 and 60.

Genetics appears to play a central role in the development of the disease, accounting for between 40 percent to 65 percent of all cases, according to a 2017 study published in The Lancet. While the exact mechanisms have yet to be identified, people with autoimmune diseases are believed to have one or more genetic mutations that alter the way that the immune system recognizes and attacks disease-causing agents.

In a normally functioning immune system, a family of genes called the human leukocyte antigen (HLA) complex helps the immune system distinguish its own cells from those of foreign invaders such as viruses and bacteria. With rheumatoid arthritis, certain HLA mutations may inadvertently instruct the body to attack its own cells. One of the most common is a mutation known as HLA-DR4.

Unsurprisingly, rheumatoid arthritis tends to run in the family.

In fact, having a family history of the disease can increase your risk by as much as 300 percent.

Other factors, such as obesity and smoking, can also contribute. Obesity not only places stress on affected joints, the excessive accumulation of fat cells triggers a pro-inflammatory effect. Smoking, meanwhile, can increase the risk of symptomatic disease by as much as 300 percent, particularly in white men who are long-term, heavy smokers,

Diagnosis

There is no single lab test or X-ray that can diagnose rheumatoid arthritis. To make the diagnosis, the doctor would need to review your medical history, perform a physical exam, and order a combination of lab and imaging tests.

The lab tests traditionally used include:

    X-rays and magnetic resonance imaging (MRI) can be used throughout the course of the disease to evaluate the progression of the disease and monitor the effectiveness of treatment.

    Treatment

    While there is no cure for rheumatoid arthritis, the introduction of newer biologic drugs has given hope to those who have failed to find relief with traditional pain relievers and steroids. Treatment today usually includes a combination of medication types.

    Among them:

    • Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) can help alleviate the pain and inflammation of mild to moderate rheumatoid arthritis. Stronger NSAIDs are available by prescription. Side effects include stomach irritation, high blood pressure, ringing in the ears, stomach ulcers, and liver toxicity.
    • Corticosteroid drugs, such as prednisone, can provide short-relief of pain and inflammation while slowing joint damage. Side effects may include osteoporosis, weight gain, easy bruising, cataracts, glaucoma, and diabetes.
    • Disease-modifying antirheumatic drugs (DMARDs) work by tempering the immune response and slowing the progression of the disease. Common DMARDs include methotrexate, Arava (leflunomide), Azulfidine (sulfasalazine), and Plaquenil (hydroxychloroquine). Side effects may include an increased risk of infection and liver damage.
    • Biologic response modifiers are a newer class of DMARDs usually used in combination with methotrexate. They include includes Cimzia (certolizumab), Enbrel (etanercept), Humira (adalimumab), Orencia (abatacept), and Remicade (infliximab). Unlike earlier generation DMARDs, biologics target specific components of the immune system rather than the immune system as a whole. Side effects include an increased risk of infection.

    Physiotherapy is also an integral part of rheumatoid arthritis treatment and may use heat, ice, transcutaneous electrical stimulation, ultrasound, range-of-motion exercises, and gentle strengthening exercises. Occupational therapy may also be helpful if the arthritis is interfering with your daily life or ability to work.

    A number of complementary and alternative medicines (CAMs), such as fish oil, borage, and evening primrose have proven beneficial in supporting treatment of mild to moderate rheumatoid arthritis.

    Coping

    Rheumatoid is a life-long progressive disease that can diminish your quality of life and self-confidence if you let it. By taking proactive steps to improve your health, you can better cope and overcome some of the more challenging aspects of the disease.

    In addition to medications, weight loss and exercise can help improve your mobility and better sustain your range of motion. Even if you are already experiencing impairment, low-impact exercises like walking, swimming, biking, yoga, and tai chi can keep the joints moving without placing undue stress on joint tissues.

    Similarly, mind-body therapies can be effective in helping you cope with the pain, fatigue, and anxiety that are often part and parcel of the disease. Options include meditation, biofeedback, breathing exercises, and guided imagery. By better managing your emotional response to your symptoms, you may not only achieve a greater sense of calm but better pain control.

    A Word From Verywell

    Rheumatoid arthritis can often be isolating to people severely affected by the disease. It may not only restrict your ability to engage in everyday activities, it can rob you of your confidence and self-image as the physical ravages of disease become more apparent.

    Do not allow yourself or a loved one go it alone. Speak with friends or family and let them know what you are going through. Many people simply don't understand what rheumatoid arthritis is or the challenges people living with the disease regularly face. The more you open up and help them understand, the more able they will be to support you.

    It also helps to reach out to others who are also affected by rheumatoid arthritis. If you can’t find a support group near you, you can link up with support networks in your area through the Tucson-based Arthritis Foundation.

    Sources:

    Singh, J.; Saag, K.; Bridges, L. et al. "2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis." Arthritis Care Res. 2016: 68(1);1-25. DOI: 10.1002/acr.22783.

    Smolen, J.; Aletaha, D.; and McInnes, I. “Rheumatoid arthritis.Lancet. 2017; 388(10055):2023-38. DOI: 10.1016/So140-6736(16)30173-8.

    Sugiyama, D.; Nishimura, K.; Tamaki, K. et al. “Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies.Annals Rheum Dis. 2010; 69(1):70-81. DOI: 10.1136/ard.2008.096487.

    More From Verywell in An Overview of Rheumatoid Arthritis