Rheumatoid Arthritis (RA) is a chronic (long-term) condition that causes pain, swelling, and stiffness in the joints. It is a systemic rheumatic disease, which means that the disease can affect the entire body.
It is one of the most common types of inflammatory arthritis and is estimated to affect 1% of the population.
RA is an autoimmune disease, meaning that it occurs when the body’s immune system attacks its own healthy cells and tissues. The reason why it does this is not well understood. When the body’s immune system is “activated” in this way, it can make a person feel very tired, similar to when they have the flu.
It is very important that RA is treated as early and aggressively as possible to put out the “fire” in patients’ joints. This prevents further joint damage that can ultimately have crippling effects, and can reduce the risk of other problems associated with chronic inflammation, such as heart disease.
People usually notice the first signs of RA between the ages of 25 and 50. The disease is about three times more common in women than men.
With proper treatment, many patients with RA can enjoy active and productive lives, and prevent long-term damage to their joints.
Rheumatoid arthritis causes pain and swelling in the joints. This causes them to feel stiff and sore, especially in the morning. Rheumatoid arthritis usually starts slowly and affects only a few joints. It might start in a knee, a wrist, the hands, or even the feet. Over weeks to months, it can start to affect other joints.
In some people, RA seems to jump around from joint to joint. One day one joint will be stiff and sore, and then the next day that joint feels fine but something else is sore. When this happens, people might start to feel like they’re going crazy. Some patients describe RA as having a mind of its own.
Although it’s rare, RA can sometimes seem to appear suddenly overnight. Those unlucky people might go to bed feeling well, but in the morning they might feel like they can’t get out of bed.
Fatigue is a common symptom because the body’s immune system is “activated” and attacking its own joints and tissues. This can make a person feel very tired, similar to when they have the flu.
Like many other autoimmune disorders, RA tends to flare. These are periods of increased activity where signs and symptoms are more pronounced and severe, versus other periods when they are more mild.
RA can also affect other organs and tissues throughout the body including the skin, eyes, lungs, heart, kidneys, glands, nerves, bone marrow and blood vessels. This can cause a variety of other symptoms depending on which parts of the body are affected.
Rheumatoid arthritis is best diagnosed by a rheumatologist, a type of doctor that is a specialist in arthritis and autoimmune diseases.
To diagnose RA, a doctor will take a complete history and perform a thorough physical examination. They will usually order blood tests and x-rays to help confirm their diagnosis.
Common Tests to Diagnose RA
No single test can diagnose RA so the doctor will piece together clues from all of their investigations to reach the diagnosis. In some patients, certain blood tests can appear normal even though they have RA.
Looking for inflammation: RA is an inflammatory arthritis so these tests are expected to have abnormal results. Common tests include a Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), and C-Reactive Protein (CRP).
Looking for antibodies – Rheumatoid Factor: Rheumatoid Factor (RF) is a type of autoantibody, an antibody that target the body’s own tissues. Elevated levels are present in 80% of people with RA. Positive tests are possible from other causes, and people who test negative can still have RA, so the test results are taken into context with other symptoms and tests.
Looking for antibodies – anti-CCP: The Anti-Cyclic Citrullinated Peptide Antibody (anti-CCP) test looks for anti-citrullinated protein antibodies (ACPAs). These are autoantibodies, or antibodies that target something the body’s own tissues are made of. ACPAs specifically target a type of protein that is described as citrullinated. This type of autoantibody is present in 60-70% of people who get RA. Since not everyone with RA will test positive, the test results are taken into context with other symptoms and tests.
X-Rays: X-rays can show damage to the joints caused by RA and can help doctors track the progression of the disease over time.
Rheumatoid arthritis (RA) is an autoimmune disease that occurs when the body’s immune system begins to attack its own joints for reasons that are not yet understood.
A variety of factors may be involved including genetics, hormones, and environmental factors.
Rheumatoid arthritis should be treated early and aggressively. Research tells us that if RA is treated early, patients are much more likely to get into remission, a state where they no longer feel the signs or symptoms of the disease. Even a few months can make a difference.
RA is linked to heart disease, so patients should also keep their blood pressure and cholesterol at healthy levels. For those with diabetes, it’s important to keep blood sugar under control. Any patients who smoke should quit as soon as possible because smoking is known to worsen symptoms and can make RA a lot more difficult to treat.
It is important for patients to attend their rheumatologist appointments regularly, and promptly get any blood tests requested by their doctors.
In the most severe cases of RA, some joints can become so badly damaged that they no longer function. If this happens, surgery might help. Surgery usually involves replacing a damaged joint with an artificial joint. Surgery can help people with severe, advanced RA by reducing pain, improving mobility, and restoring function.
Medications for RA fall into two broad groups. The first group is medications that help control the symptoms of RA. The second group of medications control the disease and prevent long-term joint damage. Patients prescribed any of these should ask their doctor to confirm that alcohol, or any supplements or alternative therapies they take, will not cause negative interactions. No known natural remedies or complementary therapies that have been proven to help RA in any significant way.
NSAID Medications for Inflammation and Pain
Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that reduce the inflammation of joints caused by RA. They also help to reduce symptoms such as pain. There are about 20 different anti-inflammatory medications available, so if one doesn’t work for someone, their doctor can recommend another one to try. NSAIDs do not prevent disease progression.
Medications like prednisone can help control inflammation in some people. It can also help control symptoms of pain and stiffness. It is usually used in high doses for short periods of time. When used for long periods of time, prednisone can have side effects.
Some people with RA also benefit from cortisone injections directly into affected joints.
People with RA should to discuss the risks and benefits of using corticosteroids with their rheumatologist.
Analgesic Medications for Pain
Analgesic medications only control pain. They do nothing to control the disease or to prevent further joint damage. Analgesics can range from simple things like acetaminophen (paracetamol, Tylenol) to more potent narcotics like morphine.
Disease Modifying Anti-Rheumatic Drugs (DMARDs)
Disease Modifying Anti-Rheumatic Drugs (DMARDs) should be used to treat everyone with Rheumatoid Arthritis. They are often used in combination to provide effective treatment.
Methotrexate is the most commonly used DMARD to treat RA. It is given once a week as tablets or a small injection under the skin. The injection tends to work better than the tablets and can have fewer side effects.
Other types of DMARDs work well for treating RA include: Sulfasalazine, Arava (leflunomide), Gold (myochrisine), and Plaquenil (Hydroxychloroquine). DMARDs are often combined together. A common combination called triple therapy consists of Methotrexate, Sulfasalazine, and Plaquenil.
Patients with RA whose joint pain and stiffness aren’t adequately controlled by anti-inflammatory medications and DMARDs can be treated by a class of medications called advanced therapeutics. Advanced therapeutics consist of biologic medications and small molecules. These medications are extremely effective and can make a big difference for people with the disease.
A type of biologic called anti-TNF biologics was first introduced in 1998. These work very well for many people with PsA. Today, a number of anti-TNF biologics are available including Humira, Remicade/Inflectra/Remsima, Enbrel, Cimzia, and Simponi. Other biologics target other aspects of the inflammatory response, including Orencia, Rituxan, Actemra, Kevzara, and Kineret. Biologics are given by an injection under the skin or an intravenous infusion.
A newer class of medications called small molecules which block other parts of the immune system can be very effective treatments. Examples of available small molecules include Xeljanz.
With many advanced therapeutics to choose from, if one doesn’t work for someone, their rheumatologist may suggest another.
Living with RA
The pain and stiffness caused by RA can sometimes limit people’s normal activities, including work. There are many things people can do to lessen the impact of RA on their work and daily routine.
We recommend adjusting features of the workplace to help make working with RA easier. For example, people that sit for much of the day can adjust the position of chairs and desks for proper posture. Vehicle seats can be adjusted to make driving more comfortable and reduce stress on joints and affected tissues.
Those who find out they have RA while they’re still young can consider choosing work that isn’t physically demanding on their joints and back.
Exercise is important to overall health. It also helps keep the joints moving properly, and helps protect them by strengthening the muscles around them.
The level and amount of exercise people with RA can do depends on the activity of their disease.
A trained arthritis physiotherapist is the best person to help design an exercise program tailored to the needs of patients with RA.
The following are some useful articles on exercising with arthritis:
Exercise and Arthritis: An article by arthritis physiotherapist Marlene Thompson
Exercising in a Flare: Another excellent article by Marlene Thompson on how to cope with flares through your exercise routine.
Alcoholic beverages are not an effective treatment for RA, and they can interact with many medications.
People with RA that plan on drinking should ask their doctor about possible negative interactions with the medications they take.
Some examples of medication that mixes poorly with alcohol includes, and is not limited to: the DMARDs methotrexate, Arava (leflunomide), and Imuran (azathioprine).
Smoking is not healthy for people with RA. It can make symptoms worse and harder to treat.
Research has shown that some arthritis medications do not work as well in people who smoke.
We recommend that smokers quit immediately to reduce the impact of their symptoms, improve the effectiveness of their medications, and improve their overall health.
Smoking significantly increases the risk of cardiovascular disease. The chronic (long-term) inflammation caused by rheumatic diseases like RA already increases this risk without a big extra boost from smoking.
Smoking can make RA nodules (lumps under the skin caused by RA and seen in some patients) worse.
Travel is still possible when you have RA.
It is best for people with this disease to get organized well in advance of a trip to ensure a smooth, comfortable, and enjoyable time.
Check out our Travel Checklist page.
Though RA does not particularly cause a loss of sex drive, it can cause pain, fatigue and emotional hardships. These hardships risk creating barriers to sexual needs, ability, and satisfaction.
People with RA can take comfort knowing that sex and intimacy can be maintained. In many cases, it can help draw partners closer together, especially through improved communication.
For more information on intimacy and arthritis, a great book is: Rheumatoid Arthritis: Plan to Win by Cheryl Koehn, Taysha Palmer and John Esdaile.
Rheumatoid Arthritis (RA) has no effect on fertility. The chances of getting pregnant for people with RA are the same as with people that don’t have it. RA also has no known effects on the developing fetus or the newborn.
The two main issues doctors worry about with RA and pregnancy are:
Patients with RA might be treated with a number of medications that can affect pregancies including NSAIDs, anti-TNF biologics, and occasionally DMARDs. It is important for people with RA who want to become pregnant to discuss their medications with their doctor and create a pre-pregnancy plan. A plan is important for a number of reasons. For example, discontinuing a particular medication for safety of the newborn might cause RA to flare, so its wise to have a plan in place to handle these possibilities.
Following the basics of healthy eating can help improve health and well-being in everyone, including those with RA. Keeping a healthy weight helps reduce the load on weight-bearing joints including the spine, hips, and knees, making it easier to live with the disease.
Unfortuantely, no special diet has ever been proven to significantly alter the course of RA or any other types of arthritis.
In addition, no known natural remedies or complementary therapies have been proven to help RA in any significant way.
People with RA should consult with their doctor to make sure that any supplements or alternative therapies they consume will not negatively interact with their medications.
Its very important for people with RA to attend regularly scheduled appointments with their rheumatologist, and promptly get any tests that are ordered by their doctors.
It is often very important that medications are taken exactly as prescribed. Patients should always talk to their doctor about any issues they experience, or if they would like to change anything.
Rheumatoid Arthritis is a chronic disease and a rheumatologist is the best partner in helping patients achieve the best quality of life possible.
RheumInfo Patient Tools
RheumInfo has created an online symptom assessment for RA patients to complete shortly before they visit their rheumatologist. The tool provides a summary report in PDF format that patients can show to their doctor at the start of their appointment. The report summarizes the patient’s overall condition so they can spend more time with their doctor, and get more value out of their visit.