An Overview of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic, autoimmune, inflammatory type of arthritis. The joints are primarily affected by rheumatoid arthritis, and some joints are more commonly affected than others. But as anyone with the disease can tell you, there may be systemic effects as well.

There are 1.5 million adults in the United States with rheumatoid arthritis. While rheumatoid arthritis is the most common type of chronic inflammatory arthritis, osteoarthritis is the most common type of arthritis overall, affecting 27 million Americans.

Rheumatoid arthritis usually develops between 30 and 50 years of age, but it can develop in anyone at any age. Rheumatoid arthritis affects three times more women than men.

Cause and Risk Factors of Rheumatoid Arthritis

The precise cause of rheumatoid arthritis is not known. Despite that fact, there are certain factors that increase the risk of developing rheumatoid arthritis or that may trigger the disease in an individual. The disease is most likely to develop in a person with susceptibility or risk factors when they are exposed to something that initiates or triggers the autoimmune and inflammatory processes.

Common Signs and Symptoms Associated With Rheumatoid Arthritis

There are certain characteristics and physical symptoms that point to rheumatoid arthritis. Some of them are present early on, while others develop over time. Here are a few:

  • Warmth, swelling, stiffness, and pain that often begins in the small joints of fingers and toes. One large joint may be initially involved, with the discomfort then moving to another. It may even seem to come and go early in the disease course. As the disease progresses, most people with rheumatoid arthritis have pain and inflammation in joints of the arms and legs.
  • Affected joints are usually symmetrical (same joint affected on both sides of the body, such as both knees).
  • Morning stiffness lasting at least an hour or more is typical.
  • Rheumatoid nodules (subcutaneous lumps) may be present.
  • Joint deformities may develop due to cartilage, tendon, and ligament damage.
  • Fatigue, loss of appetite, low-grade fever, and malaise are not uncommon .

Typically, rheumatoid arthritis symptoms develop insidiously or gradually. In fact, symptoms may not be alarming at first, and you might feel inclined to wait before consulting a doctor. For example, fatigue or low-grade fever may precede the significant joint pain and stiffness that eventually prompts you to get checked out.

Clearly, joint symptoms are the most recognized issues associated with rheumatoid arthritis. But there is a host of other problems that can develop, depending on which tissues in the body become inflamed. Some examples, to name a few,  include:

  • Pericarditis (inflammation of the lining of the chest cavity and around the heart)
  • Pleuritis (inflammation of the lining of the lungs)
  • Scleritis (inflammation of the sclera within the eye)
  • Vasculitis (inflammation of the blood vessels)

Diagnosing Rheumatoid Arthritis

It is a well-stated and accepted medical fact that early diagnosis and early treatment of rheumatoid arthritis is imperative.

There is a "window of opportunity" that offers the best chance to bring rheumatoid arthritis under control so that disease progression can be slowed and permanent joint damage prevented.  Often, joint damage occurs within the first two years following the onset of rheumatoid arthritis. 

What complicates matters is that no two cases of rheumatoid arthritis are exactly alike, and the disease course is unpredictable. Some patients experience a lot of pain, even if their X-rays don't reveal evidence consistent with severe joint damage. Some patients have evidence of severe joint damage on X-ray, but do not experience a lot of pain. Differences between patients make it necessary for a rheumatologist to observe the entire clinical picture (medical history, physical exam, imaging, and blood tests) in order to formulate an accurate diagnosis and choose the best treatment plan.

There is a misconception that the rheumatoid factor blood test is the sole test result needed to formulate the diagnosis; there is no single test that can be used to definitively identify rheumatoid arthritis.

Rheumatoid factor is an immunoglobulin (antibody) that can bind to other antibodies (normal proteins found in the blood that function within the immune system). About 80 percent of adults who have rheumatoid arthritis are positive for rheumatoid factor (i.e., seropositive rheumatoid arthritis). Approximately 20 percent of rheumatoid arthritis patients are negative for rheumatoid factor (i.e., seronegative rheumatoid arthritis).

Another blood test that is an important part of the diagnostic process for rheumatoid arthritis is the anti-CCP test. An anti-CCP test can detect autoantibodies against citrullinated proteins that have an extremely high specificity for rheumatoid arthritis. Its high specificity, around 90 percent, is why the anti-CCP test is relevant. In other words, anti-CCP antibodies have not been found at a significant frequency in other diseases.

Not to be overlooked, there are numerous diseases that mimic rheumatoid arthritis and have overlapping symptoms, making things even trickier for your rheumatologist/diagnostician. Ruling out the other conditions is part of the diagnostic process for rheumatoid arthritis as well.

Treating Rheumatoid Arthritis

If you look back a few decades, you will find that a conservative approach to the treatment of rheumatoid arthritis was favored. The lowest dose of medication that effectively controlled pain and inflammation was used. In the 1970s, methotrexate was not even FDA-approved. Today, it's considered the gold standard for treating rheumatoid arthritis. Plus, in 1998, the first injectable biologic was approved and marketed, and a slew of biologic drugs have followed. 

What experts have learned over the years is that early (the earlier the better), aggressive treatment offers the best chance to bring rheumatoid arthritis under control. The American College of Rheumatology (ACR) has laid out guidelines for using DMARDs and biologic drugs for the treatment of rheumatoid arthritis.

Some people with rheumatoid arthritis also use natural treatment options as alternative or complementary treatments for rheumatoid arthritis. While there is no cure for the disease, managing rheumatoid arthritis and maintaining quality of life is the goal. The optimal result of treatment, of course, would be a remission in rheumatoid arthritis.

Whether you choose a traditional treatment path or an alternative path, or a combination of both, do your best to stay active. Physical activity, to whatever level is possible for you, will help you decrease pain, preserve the health of unaffected joints, and help prevent further damage in your affected joints.

Your Future With Rheumatoid Arthritis

Again, early treatment can help minimize the impact of rheumatoid arthritis. That said, this disease can have a great impact on daily activities. Unfortunately, for some, it can cause disability.

More than 30 percent of adults with doctor-diagnosed arthritis (all types) report a work limitation due to arthritis. According to the Johns Hopkins Arthritis Center, disability is even higher among people with rheumatoid arthritis, with 60 percent being unable to work 10 years after the disease begins.

Older medical literature suggests that people with rheumatoid arthritis may live 10 to 15 years less than peers without the disease. But, remember, many factors influence life expectancy, including your personal lifestyle choices. 

According to the National Rheumatoid Arthritis Society, other factors include:

  • Your overall health
  • Family history
  • Age when your RA began and activity of the disease early on
  • Quality of life
  • Extent of joint damage (as seen on x-rays)
  • Being positive for both types of rheumatoid arthritis associated antibody (rheumatoid factor and anti-CCP)

Seeing a rheumatologist early on is important to being able to live your best life with RA.

The newest class of arthritis drugs, referred to as biologics, may positively impact the prognosis and life expectancy in people with rheumatoid arthritis—welcome news for anyone with the disease. A meta-analysis published in 2016 in Joint Bone Spine revealed that TNF blockers effectively reduce chronic inflammation in people with rheumatoid arthritis, decrease mortality, and reduce the risk of cardiovascular events—all without significantly increasing the risk of cancer compared to conventional disease-modifying antirheumatic drugs (DMARDs).

A Word From Verywell

Even with physical and functional limitations, you can have a good quality of life with rheumatoid arthritis. Expect challenges that range from the physical to the emotional and even the financial. It is challenging, it may be life-changing, but you can find solutions and take action. Keeping a positive attitude and persevering, with help from your support team, is what will help get your through. We are here with you every step of the way, providing you with the information you need to manage your RA confidently.

Sources:

Arthritis Data and Statistics. Centers for Disease Control and Prevention. Updated April 14, 2016.

Diagnosis and Differential Diagnosis of Rheumatoid Arthritis. Venables and Maini. UpToDate. Updated January 22, 2016.

How Is Lifespan Affected by RA? Holly John BM BS MRCP PhD et al. National Rheumatoid Arthritis Society. Original article: 08/14/2001. Reviewed: 07/04/2016

Joint Bone Spine. de la Forest DM et al. 2016 Jun 21. pii: S1297-319X(16)30050-1.

Rheumatoid Arthritis. Ruderman and Tambar. American College of Rheumatology. August 2013.

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