What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a long-term (chronic) disease that causes inflammation
of the joints. The inflammation can be so severe that it affects how the joints and
other parts of the body look and function. In the hand, RA may cause deformities in
the joints of the fingers. This makes moving your hands difficult. Lumps, known as
rheumatoid nodules, may form anywhere in the body.
Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or
younger. It causes inflammation and joint stiffness that last for more than 6 weeks.
Unlike adult RA, which lasts a lifetime, children often outgrow JRA. But the disease
can affect bone development in a growing child.
What causes rheumatoid arthritis?
The exact cause of RA is not known. RA is an autoimmune disorder. This means the body's
immune system attacks its own healthy cells and tissues. This causes inflammation
in and around the joints. This may damage the skeletal system. RA can also damage
other organs, such as the heart and lungs. Researchers think certain factors, including
heredity, may be a factor.
RA most often occurs in people from ages of 30 to 50, but it can occur at any age.
It happens more in women than in men.
What are the symptoms of rheumatoid arthritis?
The joints most often affected by RA are in the hands, wrists, feet, ankles, knees,
shoulders, and elbows. The disease often causes inflammation in the same areas on
both sides of the body. Symptoms may begin suddenly or slowly over time. Each person’s
symptoms may vary, and may include:
- Stiffness, especially in the morning
- Swelling over the joints
- Decreased movement
- Pain that is worse with joint movement
- Bumps over the small joints
- Trouble doing activities of daily living (ADLs), such as tying shoes, opening jars,
or buttoning shirts
- Trouble grasping or pinching things
- Tiredness and lack of energy (fatigue)
- Occasional fever
These symptoms can seem like other health conditions. Always see your healthcare provider
for a diagnosis.
How is rheumatoid arthritis diagnosed?
Diagnosing RA may be difficult in the early stages. This is because symptoms may be
very mild, and signs of the disease may not be seen on X-rays or in blood tests. Your
healthcare provider will take your medical history and give you a physical exam. Tests
may also be done, such as:
- X-ray. This test uses a small amount of radiation to create images of internal tissues,
bones, and organs onto film.
- Joint aspiration. For this test, a small fluid sample is taken from a swollen joint. It is done to
look for signs of infection or gout.
- Nodule biopsy. Tiny tissue samples are taken to look at under a microscope. This helps to check
for cancer or other abnormal cells.
- Blood tests. These tests are done to find certain antibodies, called rheumatoid factor, cyclic
citrullinated antibody, and other signs of RA.
- Ultrasound or MRI. These imaging tests can look for bone damage and inflammation.
How is rheumatoid arthritis treated?
Your healthcare provider will figure out the best treatment for you based on:
- How old you are
- Your overall health and medical history
- How sick you are
- How well you handle certain medicines, treatments, or therapies
- If your condition is expected to get worse
- Your opinion or preference
There is no cure for RA. The goal of treatment is often to limit pain and inflammation,
and help ensure function. You may have 1 or more types of treatments. Treatment may
- Medicines. Some medicines may be used for pain relief. Some are used to treat inflammation.
Others can help to slow the disease from getting worse. Medicines should be managed
by a rheumatologist. This is a doctor who specializes in arthritis and rheumatic diseases.
You may need regular blood tests to check how the medicines affect your blood cells,
liver, and kidneys.
- Splints. Splints may be used to help protect the joints and strengthen weak joints.
- Physical therapy. Physical therapy may be used to help increase the strength and movement of the affected
In some cases, surgery may be an option if other treatments don’t work. Surgery does
not cure RA. It helps correct the deformities caused by the disease. After surgery,
RA can still cause problems. You may even need more surgery. Joint repair or reconstruction
can be done in many ways, including:
- Surgical cleaning. This surgery removes inflamed and diseased tissues in the hands to help increase
- Joint replacement (arthroplasty). This type of surgery may be used in cases of severe arthritis of the hand. It may
be done on older adults who are not so active. Joint replacement may reduce pain and
help increase joint function. During the surgery, a joint that has been destroyed
by the disease is replaced with an artificial joint. The new joint may be made out
of metal, plastic, or silicone rubber. Or it may be made from your own tissue, such
as a tendon from another part of your body.
- Joint fusion. For this surgery, a joint is removed, and the two ends of bones are fused together.
This makes one large bone without a joint. This is usually done on patients with advanced
RA. After the bone fusion, the fused joint can’t move.
Complications of rheumatoid arthritis
Because RA damages joints over time, it causes some disability. It can cause pain
and movement problems. You may be less able to do your normal daily activities and
tasks. This can also lead to problems such as depression and anxiety.
RA can also affect many nonjoint parts of the body, such as the lungs, heart, skin,
nerves, muscles, blood vessels, and kidneys. These complications can lead to severe
illness and even death.
Living with rheumatoid arthritis
There is no cure for RA. But it is important to help keep your joints working well
by reducing pain and inflammation. Work on a treatment plan with your healthcare provider
that includes medicine and physical therapy. Work on lifestyle changes that can improve
your quality of life. Lifestyle changes include:
- Activity and rest. To reduce stress on your joints, switch between activity and rest. This can help
protect your joints and lessen your symptoms.
- Using assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and to improve
- Using adaptive equipment. Reachers and grabbers let you extend your reach and reduce straining. Dressing aids
help you get dressed more easily.
- Managing use of medicines. Medicines for this condition have some risks. Work with your healthcare provider
to create a plan to reduce this risk.
- Seeking support. Find a support group that can help you deal with the effects of RA.
When should I call my healthcare provider?
Tell your healthcare provider if your symptoms get worse or you have new symptoms.
Key points about rheumatoid arthritis
- RA is a long-term (chronic disease) that causes joint inflammation.
- RA can also affect many nonjoint areas such as the lungs, heart, skin, nerves, muscles,
blood vessels, and kidneys.
- RA may cause deformities in the joints of the finger, making movement difficult.
- The joints most often affected by RA are in the hands, wrists, feet, ankles, knees,
shoulders, and elbows.
- Symptoms may include joint pain, stiffness, and swelling; decreased and painful movement;
bumps over small joints; and fatigue or fever.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that
- Know how you can contact your provider if you have questions.