What Is Rheumatoid Arthritis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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illustration of joint pain related to rheumatoid arthritis
Rheumatoid arthritis causes pain and swelling in the joints; if untreated, the inflammatory disease may damage cartilage and bone.iStock

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints. Within the body, joints are the points where bones come together and allow for movement. Most of these joints — those called synovial joints — also provide shock absorption.

RA is an autoimmune condition, in which your immune system mistakes the linings of your joints as "foreign" and attacks and damages them, resulting in inflammation and pain.

This disease most often affects the joints of the hands, wrists, and knees symmetrically. There is no cure, but RA can be managed with good treatment, according to the Centers for Disease Control and Prevention (CDC).

Common Questions & Answers

What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune condition in which your immune system mistakes the linings of your joints as foreign and attacks them. The damage results in inflammation and pain.
What is the difference between rheumatoid arthritis and osteoarthritis?
Rheumatoid arthritis inflames the joint lining, eventually eroding the joint. With osteoarthritis, multiple causes may damage the cartilage that covers the ends of the bones in a joint. The most common type of arthritis, osteoarthritis is considered more of a mechanical (wear and tear) disease.
How is RA diagnosed?
No single test can diagnose rheumatoid arthritis. Doctors consider symptoms such as joint swelling and morning stiffness. Blood tests detect rheumatoid factor and anti-citrullinated protein antibodies (ACPAs), which are markers for systemic inflammation. X-ray, ultrasound, and magnetic resonance imaging (MRI) scans can help determine joint health.
Can RA be fatal?
RA is not generally considered a lethal disease. The disease can usually be managed with medication.
Are there home remedies for rheumatoid arthritis?
Exercise is an essential aspect of RA treatment, consisting of stretching, aerobics, and strength training. For pain and inflammation, try heat treatment to soothe stiff joints, or cold treatments for acute pain, as well as over-the-counter topical ointments and specialized braces or splints that support the joints.

Signs and Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis is a complex disease that is not well understood by medical practitioners or researchers.

Early signs of disease, such as joint swelling, joint pain, and joint stiffness, typically begin in a gradual and subtle way, with symptoms slowly developing over a period of weeks to months and getting worse over time. RA usually begins in the small bones of the hands (particularly those at the base and middle of the fingers), base of the toes, and wrists. Morning stiffness that lasts for 30 minutes or more is another hallmark symptom of RA, per the Arthritis Foundation.

RA is a progressive disease. When left untreated, inflammation can start to develop in other parts of the body, causing various potentially serious complications that can affect other organs, such as the heart, lungs, and nerves, and could cause significant long-term disability.

If you're experiencing RA symptoms, it's crucial to get diagnosed as soon as possible so that you can receive prompt treatment.

Learn More About Rheumatoid Arthritis Signs and Symptoms

Causes and Risk Factors of Rheumatoid Arthritis

RA develops when white blood cells, which normally protect the body from foreign invaders such as bacteria and viruses, enter the synovium (the thin tissue that lines the synovial joints). Inflammation ensues — the synovium thickens, causing swelling, redness, warmth, and pain in the synovial joint.

Over time, the inflamed synovium can damage the cartilage and bone within the joint, as well as weaken supportive muscles, ligaments, and tendons.

Researchers don't know exactly what causes the immune system to invade the synovium, but it's believed that genes and environmental factors play a role in the development of RA.

Research suggests that people with certain genetics, namely the human leukocyte antigen (HLA) genes, have a significantly increased risk of developing RA.

The HLA gene complex controls immune responses by producing proteins that help the immune system recognize proteins from foreign invaders.
A number of other genes also appear to be associated with RA susceptibility, including STAT4, PTPN22, TRAF1-C5, PADI4, CTLA4, among others, according to a report in the journal Rheumatology.

But not everyone with these identified gene variants develops RA, and people without them can still develop it. So, it's likely that environmental factors often trigger the disease, particularly in people with a genetic makeup that makes them more susceptible to it. These factors include:

  • Viruses and bacteria (though certain infections may reduce RA risk, at least temporarily)
  • Female hormones
  • Exposure to certain kinds of dust and fibers
  • Exposure to secondhand smoke

  • Obesity, which also increases progression of disability for people with RA.

    Obese patients are less likely to achieve RA remission regardless of the treatment they receive.

  • Severely stressful events
  • Foods
Equally important are smoking and a family history of RA in increasing a person's risk of developing the condition.

Children up to age 16 who experience prolonged swollen or painful joints anywhere in the body are typically diagnosed with juvenile idiopathic arthritis (JIA).

Learn More About Juvenile Idiopathic Arthritis: Symptoms, Causes, Diagnosis, and Treatment


How Is Rheumatoid Arthritis Diagnosed?

While no single test can definitively diagnose RA, doctors consider several factors when evaluating a person for rheumatoid arthritis.

The diagnostic process typically begins when a doctor gets your medical history and conducts a physical exam. They will ask you about your symptoms to look for signs of RA, in particular things like prolonged joint swelling and morning stiffness that lasts at least half an hour after you wake up.

Next, your doctor will order blood tests to detect rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), which can be specific markers for RA and could indicate RA. You can still have symmetrical inflammatory arthritis with or without systemic markers of inflammation.

Imaging tests such as X-rayultrasound, and magnetic resonance imagery scans may be used to help a doctor determine if your joints have been damaged or to detect joint inflammation, erosion, and fluid buildup.

In the future, doctors may be able to diagnose RA using (noninvasive) infrared light.

The Different Types of Rheumatoid Arthritis

Rheumatoid arthritis is classified as either seropositive or seronegative.

People with seropositive RA have ACPAs, also called anti-cyclic citrullinated peptides, found in their blood test. These antibodies attack the synovial joints and produce symptoms of RA.

About 60 to 80 percent of people diagnosed with RA have ACPAs, and for many people, the antibodies precede the symptoms of RA by 5 to 10 years, notes the Arthritis Foundation.

People with seronegative RA have the disease without the presence of the antibodies or RF in their blood.

Learn More About Diagnosing Rheumatoid Arthritis: Tests and Screenings, Early Diagnosis, and Your Doctors

Duration of Rheumatoid Arthritis

RA is a progressive and chronic disease. Damage to the joint bones occurs very early in the progression of the disease, typically within the first two years, according to the Johns Hopkins Arthritis Center.

That's why early treatment is so important.
With effective, early treatment, most people with RA can live as they normally would, and many people can achieve remission of symptoms. This doesn't mean that you're cured but rather that your symptoms are alleviated to the point where you can function at your fullest and your joints are not being further damaged by RA. It's also possible to achieve remission and then relapse, or have your symptoms return.

But remission doesn't happen for everyone, and because the pain and other symptoms of RA may change over time, pain management can be an ongoing concern. In addition to pain medications like nonsteroidal anti-inflammatory drugs and corticosteroids, there are many options for pain relief for people living with RA. These include, among others:

Learn More About How Rheumatoid Arthritis Progresses

Treatment and Medication Options for Rheumatoid Arthritis

To treat RA, doctors aim to stop the progression of the disease by reducing symptoms, controlling inflammation, minimizing joint and organ damage, and improving physical function.

Proven treatments include medication and physical therapy. Early, aggressive measures can help control symptoms and complications before the disease significantly worsens, by reducing or altogether stopping inflammation as quickly as possible.

This strategy is essential to preventing disability, and it usually amounts to treatment with anti-inflammatory drugs, and sometimes more than one medication at a time.

Medication Options

In recent years, there have been significant advancements in medicines for treating RA, but there is still no cure. Medications known as disease-modifying antirheumatic drugs (DMARDs) are considered the gold standard for RA treatment. DMARDs can change or slow the progression of the disease, helping prevent severe joint damage and other complications.

In general, these drugs work by slowing the inflammation and protecting the joints from further damage, and are generally prescribed shortly after diagnosis. The type of DMARD a doctor prescribes depends on several factors, including disease severity and the balance between the medication's benefits and potential side effects.

Biologics and JAK inhibitors are options alongside traditional DMARDs.

Traditional DMARDs target the entire immune system, while biologics work by targeting specific steps in the inflammatory process, and JAK inhibitors block action in your body to help prevent the inflammation before it starts. Traditional DMARDs are usually taken in pill form, as are JAK inhibitors; biologics are typically injected or delivered via an intravenous infusion.

JAK inhibitors can increase the risk of serious heart-related events such as heart attack or stroke, as well as the risk of cancer, blood clots, and death, especially for past or current smokers and those with existing heart conditions.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are used to treat pain and inflammation.

But the latest treatment guidelines issued by the American College of Rheumatology recommend that steroid use be minimized.

RELATED: New Medication Guidelines for Treating Rheumatoid Arthritis Released

Learn More About Rheumatoid Arthritis Medications

Alternative and Complementary Therapies for Rheumatoid Arthritis

Certain lifestyle changes and home remedies may be beneficial — in addition to the conventional treatment of medication, physical therapy, and surgery — if needed.

Some people have found relief from RA symptoms through acupuncture, tai chi, and yoga, though the scientific evidence supporting this isn't particularly conclusive. Complementary or alternative therapies, such as homeopathy, hydrotherapy, or cryotherapy, might also be worth considering to help relieve RA pain and stiffness.

Relaxation techniques, visualization exercises, group counseling, and psychotherapy can help reduce the stress of living with RA. Sleeping well is also an important part of managing symptoms.

You should always check with your medical provider before trying any complementary or alternative therapies.

Learn More About Alternative Therapies for Rheumatoid Arthritis

Many people can manage RA with medication and physical therapy, but joint surgery may be an option if your joint damage is severe and limiting your quality of life.

Learn More About Treatment for Rheumatoid Arthritis: Medications, Alternative and Complementary Therapies, Surgery Options, and More

Complications of Rheumatoid Arthritis

It's well established that rheumatic diseases such as RA increase the risks for developing a variety of health conditions.

The most common RA comorbidity is cardiovascular disease, but the condition is also associated with several specific cardiovascular issues, including heart attack, stroke, congestive heart failure, peripheral vascular disease, and atherosclerosis.

It's important for people with RA to work with their doctors to assess their heart disease risk factors, such as high blood pressure, diabetes, and smoking, and to reduce them.

RA can also lead to inflammation in other areas of the body, including blood vessels, where it's known as rheumatoid vasculitis; the lungs, resulting in rheumatoid lung disease or other conditions; the eyes; and the wrists, causing carpal tunnel syndrome.

Another possible complication is kidney impairment as a result of RA medication. And pregnant women need to be aware that RA is linked to pregnancy complications, such as hypertension (high blood pressure) during late pregnancy, and increased risk of premature delivery.

Learn More About the Complications of Rheumatoid Arthritis: How It Affects Your Body in the Short and Long Term

Dietary Modifications to Consider for Rheumatoid Arthritis

While there is a lot of interest in the role of diet and nutrition in symptom management for rheumatoid arthritis, there is no comprehensive research on the topic nor is there a dietary magic formula to fight RA symptoms.

But some evidence suggests that eating certain foods may help reduce inflammation and improve symptoms for some people, while other foods have been shown to worsen inflammation and related symptoms.

For instance, the ketogenic diet — which is high in fats that promote inflammation and low in certain healthy grains, fruits, and vegetables that help fight inflammation — is generally believed to be bad for RA symptoms and pain.

On the other hand, the Mediterranean diet is high in seafood (omega-3 fatty acids) and fiber, which can help fight inflammation. It's sometimes called the anti-inflammatory diet or arthritis diet.

Some research, including a recent review in Frontiers in Nutrition, suggests that diets that exclude animal products completely and focus on vegetables, fruits, and fiber may also be beneficial for RA.

Learn More About Rheumatoid Arthritis and Diet

Research and Statistics: Who Has Rheumatoid Arthritis?

About 1 percent of Americans live with rheumatoid arthritis. According to a 2017 report in the journal Rheumatology International, the prevalence of RA in the United States appeared to increase between 2004 and 2014, affecting about 1.3 million adults in 2014.

Similar to previous decades, the annual incidence of RA in 2005–2014 was 41 per 100,000 people, and the incidence for women and men was 53 in 100,000 and 29 in 100,000, respectively, according to a study published in the Annals of the Rheumatic Diseases in 2020.

Women are more likely than men to develop RA at an early age, and two to three times as many women as men develop RA, according to the Centers for Disease Control and Prevention (CDC).

Inflammatory arthritis can affect children. It's known as juvenile idiopathic arthritis (JIA), and it affects nearly 300,000 children in the United States, according to the U.S. National Library of Medicine.

JIA can't be diagnosed with a blood test, so doctors consider symptoms and medical history to rule out conditions that can resemble JIA, such as infections, cancer, Lyme disease, bone disorders, and lupus.

Conditions Related to Rheumatoid Arthritis

There are several kinds of arthritis ("arth" is Latin for "joint" and "itis" is Latin for "disease" or "inflammation"), including RA, osteoarthritisgout, and lupus.

Osteoarthritis is the most common type of arthritis, affecting more than 32.5 million Americans, according to the CDC.

Rheumatoid arthritis and osteoarthritis affect the body differently. In RA, the joint lining becomes inflamed and eventually erodes the joint. But in osteoarthritis, the cartilage that covers the ends of the bones in a joint is damaged by multiple different causes, and it is considered more of a mechanical (wear and tear) disease.

There are other health conditions related to rheumatoid arthritis, too. Osteoporosis, or low bone density,

as well as mental health conditions like anxiety and depression are also common in people with RA.

Pulmonary conditions are linked to RA as well. An estimated 10 percent of people with RA will develop interstitial lung disease, according to the Arthritis Foundation.

Additionally, people with RA have an increased risk of lymphomas, possibly due to chronic inflammation.

Resources We Love

Favorite Orgs for Essential Rheumatoid Arthritis Information

The American College of Rheumatology is an organization for physicians, health professionals, and scientists that advances rheumatology through education, research, advocacy, and practice support relating to the care of people with arthritis and rheumatic and musculoskeletal diseases. It publishes two medical journals (Arthritis & Rheumatology and Arthritis Care & Research) and promotes research into rheumatological conditions.

The Arthritis Foundation is a nonprofit organization dedicated to the prevention, control, and cure of arthritis. The foundation provides information and resources, access to optimal care, advancements in science, and community networking.

CreakyJoints is a leading support, education, advocacy, and research organization for people living with arthritis and rheumatic disease. It is dedicated to raising awareness of all forms of arthritis, which includes educating people about the available varieties of treatment and management strategies.

Favorite Online Support Network for RA

The Live Yes! Arthritis Network, from the Arthritis Foundation, provides a network of support with the aim of helping people live their best lives. By exchanging ideas, tips, and experiences with others in provided online forums covering a variety of topics, the network empowers people with RA to gain confidence in dealing with their disease proactively.

Favorite Apps, Products, and Gadgets

Arthritis Power App

CreakyJoints has partnered with rheumatology researchers at the University of Alabama at Birmingham to create this useful app that helps you track your symptoms and medications and share your experiences of living with RA. In addition to RA, the app also includes research for conditions such as ankylosing spondylitispsoriatic arthritis; psoriasis; osteoporosisosteopenia, and low bone mineral density; osteoarthritis; fibromyalgia; gout; juvenile idiopathic arthritis; inflammatory bowel diseases, like Crohn’s and ulcerative colitis; lupus; scleroderma (systemic sclerosis); polymyositis; and dermatomyositis.

Dycem Super Grip Tape, $13.95

Dycem's self-adhering Super Grip Tape provides a cushioned grip that feels more comfortable on the hands. The tape adheres to a variety of surfaces, including brooms, wheelchair arms, mobility devices, and even pens and cutlery. The nonslip grip will help increase the friction of any surface you grab.

Besmon Electric Jar Opener, $22.99

This jar opener can handle any jar with lids that are 1 to 3.5 inches in diameter. It’s recommended for people with arthritis, to save your joints the strain of twisting stubborn lids.

Hamilton Beach Smooth Touch Electric Can Opener $31.85

The Smooth Touch can open both pop-top and regular cans. It is designed so that it cuts along the side of the can and not the top, minimizing the blade's contact with food, preventing splashing, and creating a smooth, touchable lid.  

IMAK Compression Arthritis Gloves, $20.99

Many people with rheumatoid arthritis consider compression gloves a must-have accessory. According to research published in Therapeutic Advances in Musculoskeletal Disease, hand symptoms including pain, stiffness, and swelling improve greatly with the use of compression gloves. IMAK remains one of the easiest brands of gloves to find, both online and in stores.

Sunbeam Warming Blanket

Sunbeam's electric blanket can help those with arthritis get off to a better start in the morning by providing the heat necessary to loosen stiff joints. An easy-to-use controller can adjust the blanket through 10 heating levels to help you warm up your joints before getting out of bed. The blanket comes in twin, full, queen, and king sizes to fit all standard-size beds.

Favorite Patient Blogs

Chronic Eileen

Over a period of two and a half years, Eileen Davidson was diagnosed with rheumatoid arthritis, osteoarthritis, and fibromyalgia. She began writing Chronic Eileen in June 2017 as a way to battle her struggles with progressing anxiety and depression and to help her handle her new role as a mother with a chronic illness (her article on parenting techniques is definitely worth a read). Her posts share many of these ideas, such as whether arthritis will make tattoos hurt or how to calm the “bitch within” when living with a chronic illness.

Carla’s Corner

With 25 years of corporate communications experience, Carla Kienast has focused her messaging skill on helping others living with rheumatoid arthritis through her blog. Diagnosed with RA in 2008, Kienast has been through 19 surgeries, including three joint replacements, two spinal fusions, and two rotator cuff operations. She describes her extraordinary experiences dealing with hip and shoulder surgeries, and covers her various, and sometimes ineffective, drug treatments, all with a sense of humor.

From This Point. Forward.

Mariah Leach was diagnosed with rheumatoid arthritis at age 25 while pursuing dual graduate degrees. Since then, she has undoubtedly made the most of living with a chronic illness, including giving birth to her third child. In addition to her blog, Leach writes for various health websites. On Mamas Facing Forward, she pays special attention to mothers living with RA in articles on sexparentingtreatment, and ordinary life with RA.

RELATED: 10 Arthritis Blogs to Watch in 2020

Favorite Annual Meetings

American College of Rheumatology Annual Meeting

Every year, nearly 16,000 rheumatologists, rheumatology health professionals, fellows in training, patient advocates, and exhibitors from more than 100 countries gather to discuss the latest scientific advances and clinical issues surrounding rheumatoid arthritis. In 2021, it will be held virtually, due to COVID-19. The annual convention hosts sessions that provide ample opportunity for professional development, networking, and access to the latest rheumatology research and clinical applications.

Rheumatoid Arthritis and COVID-19

As the novel coronavirus persists, you know you must take extra precautions to protect your health. Find the latest, most accurate information in our guide.

Learn More: A Guide to Living With RA During the COVID-19 Pandemic: Help, Resources, and Making a Personal Checklist

RELATED: 5 Things People With Rheumatoid Arthritis Must Know About the COVID-19 Vaccines

Editorial Sources and Fact-Checking

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