A Patient’s Guide to Rheumatoid Arthritis
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The human body is an incredibly complex machine. Most of the time, all the parts work correctly, with various gears and components clicking in harmony. But occasionally, something gets out of whack. When this happens, the guardian of the machine – the immune system – can get turned around and begin attacking the body it usually protects. This is what happens in an autoimmune disease like rheumatoid arthritis, an inflammatory disease that affects the joints.
The Centers for Disease Control and Prevention reports that “arthritis means inflammation or swelling of one or more joints. It describes more than 100 conditions that affect the joints, tissues around the joint and other connective tissues. Specific symptoms vary depending on the type of arthritis, but usually include joint pain and stiffness.”
Arthritis is one of the most common ailments in America. According to the CDC, more than 54 million adults in the United States – about 25 percent of all adults – have arthritis. In addition, about 300,000 children also have some form of arthritis. About 24 million people are disabled by their arthritis, making it the leading cause of disability in the U.S.
The most common form of arthritis in adults is osteoarthritis, also known as degenerative arthritis. It develops as a person ages and gets progressively worse over time. “When the cartilage – the slick, cushioning surface on the ends of bones – wears away, bone rubs against bone, causing pain, swelling and stiffness. Over time, joints can lose strength and pain may become chronic,” the Arthritis Foundation reports.
Rheumatoid arthritis is unrelated to osteoarthritis, but it’s the third most common form of arthritis in America, affecting about 1.5 million people. “It’s an incredibly serious disease,” says Dr. John J. Cush, a rheumatologist and the director of clinical rheumatology for the Baylor Scott & White Research Institute and professor of medicine and rheumatology at Baylor University Medical Center in Dallas.
Rheumatoid arthritis can develop at any time, but it most often develops in middle aged women. Several signs and symptoms could indicate that you’ve developed rheumatoid arthritis:
- Pain, redness or swelling in one or more joints throughout the body (although symptoms usually are symmetrical).
- Fever.
- Fatigue.
- Joint stiffness and pain in the morning that loosens up as you move more.
- Numbness or tingling in the extremities.
- Decreased range of motion.
- Joint deformity.
Like other types of arthritis, rheumatoid arthritis causes pain, swelling and stiffness in the joints. But many patients with rheumatoid arthritis have symptoms on both sides of the body. This symmetry is a hallmark of RA that doesn’t typically happen in other types of arthritis. RA also tends to affect more joints at once than other types of arthritis.
In addition, “it causes a fusiform type of swelling of the joint,” says Dr. Esther Lipstein-Kresch, chief of rheumatology at ProHEALTH Care in New York. “So, when you touch the joint, it feels sort of mushy as opposed to feeling bony.” This swelling is also usually symmetrical, meaning it’s about the same or can be observed on both sides of the body. “Typically, what affects one hand is going to affect the other as well. Rheumatoid arthritis can also affect large joints, including the hips, knees and ankles, and it can affect the shoulders as well,” she says. However, RA “doesn’t affect the lower spine, but it does affect the cervical spine,” meaning the neck.
Many of the symptoms of RA are similar to those of osteoarthritis, and like OA, RA is progressive in nature, wearing down the joints and your body with inflammation over time. The CDC reports “in a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance) and deformity (misshapenness).” In most patients, symptoms begin slowly and build over weeks or months. RA often begins as a little stiffness in one or more joints – often in the hands, wrists or feet.
The CDC reports “there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.” In addition to pain, swelling and stiffness, people with RA may also experience tenderness in more than one joint, weight loss, fever, fatigue and weakness in the affected limbs.
Although RA targets the joints, it can also have negative impacts on other parts of the body and increase your risk of developing other chronic diseases including heart disease, high blood pressure and diabetes. In addition, the Mayo Clinic reports that RA causes inflammation in the body that can lead to scarring within the lungs, lung nodules (small lumps in the lung) and pleural disease (inflammation of the tissue surrounding the lungs). These can all lead to breathing problems. If you have RA and experience any issues with breathing, see your doctor right away.
Inflammation is also the primary culprit behind the heart problems that some RA patients experience, the Arthritis Foundation reports. “Having RA doubles the risk of most heart problems, including heart attack, stroke and atherosclerosis – the buildup of fat, cholesterol and cellular debris (plaque) on blood vessel walls.” A 2015 Mayo Clinic study published in BioMed Research International also found that people with RA are at increased risk of developing atrial fibrillation. AF is an irregular heartbeat and significant risk factor for strokes. Dr. Roger Kornu, a rheumatologist with the University of California, Irvine School of Medicine, says “most RA patients die from heart attack or stroke.”
Some RA patients also experience eye problems, the Mayo Clinic reports. “The most common eye-related symptom of rheumatoid arthritis is dryness. Dry eyes are prone to infection, and if untreated, severe dry eyes can cause damage to the corneas, the clear, dome-shaped surface of the eye that helps your eye focus.” Dry eyes may also be a sign of Sjogren’s syndrome, another autoimmune disorder associated with RA.
The National Institutes of Health report that the exact cause of RA is unknown, but that genetics, environmental factors and hormones may all play a role in whether a person develops RA. Sex, age and lifestyle also appear to be risk factors. Women are more likely to develop RA than men. Although children and older adults may also develop RA, it most commonly strikes adults. The Arthritis Foundation reports that “in women, RA most commonly begins between ages 30 and 60. In men, it often occurs later in life. Having a family member with RA increases the odds of having RA; however, the majority of people with RA have no family history of the disease.”
Smoking has also been identified as a risk factor for RA. Exactly how they’re connected isn’t certain, but the Mayo Clinic reports “researchers suspect smoking somehow ignites faulty immune system functioning in people genetically predisposed to getting rheumatoid arthritis.”
Diagnosing RA isn’t easy; its early symptoms mimic those of many other diseases, which can make it challenging to arrive at the right diagnosis in some cases. Your doctor will perform a physical exam to check for swelling, redness and warmth in the joints and to check your reflexes and muscle strength. You’ll also likely have some blood tests looking for autoimmune markers in the blood that may indicate an elevated level of inflammation. You may also have imaging tests, such as X-rays, an MRI or ultrasound to get a closer look at what’s going on inside your joints.
If your doctor suspects that you might have RA, you’ll probably have some blood tests to look for certain inflammatory markers in the body. One such test that’s been used for years determines how much rheumatoid factor is in your blood. While rheumatoid factor is found in about 85 percent of cases, some people have normal levels of it, but still have rheumatoid arthritis. Lipstein-Kresh says these people have “what’s called zero-negative RA.”
Your doctor may also order an anti-CCP test, another blood test that looks for anti-cyclic citrullinated peptide antibodies, other proteins produced by the body that are involved with inflammation. High levels of C-reactive protein in the blood may also be associated with inflammation and could signal the presence of rheumatoid arthritis. An erythrocyte sedimentation rate test (ESR or sed rate) looks at how quickly erythrocytes (red blood cells) in a sample of blood fall in a thin, vertical tube. ESR is a non-specific test, so high rates of sedimentation simply mean the sample contains more proteins, which are heavier and fall out of solution faster. That’s typically associated with higher levels of inflammation in the blood, which could point to rheumatoid arthritis or another autoimmune or inflammatory condition. A normal result also does not rule out the possibility of a rheumatoid arthritis diagnosis.
Although rheumatoid arthritis is incurable, it can be managed with powerful medications designed to reorient your body’s immune response. The Arthritis Foundation reports that “with autoimmune and inflammatory types of arthritis, early diagnosis and aggressive treatment is critical. Slowing disease activity can help minimize or even prevent permanent joint damage.” The goal of treatment should be to manage symptoms by reducing pain, improving function, and preventing further joint damage. Common pharmaceutical treatments for this disease include:
- Non-steroidal anti-inflammatory drugs (NSAIDs). Drugs such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) can help relieve pain and reduce inflammation. Some of these drugs are available over the counter, or your doctor may prescribe stronger NSAIDs.
- Steroids. Corticosteroids bring down inflammation quickly and can also help relieve pain in more acute cases. Steroids, such as prednisone, may also slow the progression of joint damage.
- Disease-modifying antirheumatic drugs. DMARDs, which include methotrexate (Trexall), slow the progression of rheumatoid arthritis and may be used to treat other forms of inflammatory arthritis. They have long been considered the gold-standard for treating rheumatoid arthritis and have been around for a long time.
- Biologics. Over the past two decades, new immunosuppressant drugs called biologics have emerged and are offering patients an improved outlook and better management of rheumatoid arthritis. These drugs are cultivated from living cells and are typically administered as injections or via intravenous infusion. Various drugs on the market target different molecules in the body to help control inflammation. Examples include adalimumab (Humira), secukinumab (Cosentyx) and abatacept (Orencia).
In addition to medication, you may need to work with a physical or occupational therapist to learn exercises that keep the joints flexible.
In some cases, surgery is an option for treating joints damaged by RA. These procedures may include:
- Synovectomy – to remove the synovium, or lining of the joint.
- Tendon repair – to repair loose or ruptured tendons.
- Joint fusion – to stabilize or realign a joint for pain relief.
- Total joint replacement – to remove the damaged parts of a joint and insert a metal or plastic prosthesis.
Researchers are also finding that physical activity and exercise can help alleviate symptoms and slow the progression of RA. Obesity also appears to make the symptoms of RA worse, so eating right and keeping your weight in check can also help you manage the disease.
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