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(RA; Arthritis, Rheumatoid)
Rheumatoid arthritis (RA) is a disorder of the joints. It causes pain, swelling, stiffness, and loss of function in the joints.
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RA is caused by a problem with the immune system. It begins to attack healthy tissue. It is not clear what makes this happen. It is most likely a combination of factors in your genes and environment. Some known factors include:
- Genes—people with RA often have a specific genetic defect
- Defects in the immune system—may stop the immune cells from recognizing the body’s own tissues
- Infection with specific viruses or bacteria—may start an abnormal immune response
- Chemical or hormonal imbalances in the body
RA is more common in:
- People aged 30 to 60 years
Other factors that may increase your chance of developing RA include:
- Family members with RA
- Heavy or long term smoking
Symptoms involve two or more joints which are usually:
- Smaller joints
- The same joints on both sides of the body
- Increased pain and stiffness in the morning and after inactivity that lasts more than 30 minutes
- Red, swollen, warm joints
- Deformed, misshapen joints
RA may also cause:
- Intense fatigue, decreased energy
- Muscle aches
- Decreased appetite
- Weight loss
- Fever and sweats
- Small lumps or nodules under the skin
Inflammation may also occur in:
- Blood and blood vessels
The doctor will ask about your symptoms and health history. A physical exam will be done. There are many diseases that can mimic RA. Tests will help to rule out other conditions.
Tests may include:
Blood tests to look for:
- Rheumatoid factor—can be found in conditions other than RA
- Signs of an autoimmune disorder or inflammation
- Imaging tests:
Tissue sample such as:
- Synovial biopsy—a piece of the lining of the joint
- Arthrocentesis —fluid from the joint
The doctor will look at all your symptoms and test results to reach a diagnosis.
There is no cure for RA. The goal of treatment is to slow down the damage to the joint. It can also help:
- Relieve pain
- Reduce inflammation
- Help you move better
There are a variety of medicines to treat the pain and inflammation of RA. One or more of the following type of medicine may be recommended:
Nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen, cyclooxgenase-2, or COX-2 inhibitors
- May be applied to the skin or taken by mouth.
Disease-modifying antirheumatic drugs (DMARDs):
- Nonbiologics—suppress the immune system
- Biologics—attempt to repair, stimulate, or enhance the immune system
- Corticosteroids—injected into the joint (less common)
Rest and Exercise
Rest can reduce joint inflammation and pain. It can also fight fatigue.
Exercise is important for maintaining muscle strength and flexibility. It also preserves joint motion.
- Try mild strength training.
- Participate in aerobic exercise. This include walking, swimming, or dancing.
- Avoid heavy-impact exercise.
- Try a physical therapy program.
Maintain a balance between rest and exercise.
Splints may help to reduce pain. Stress on joints from daily activities may be reduced with:
- Zipper extenders
- Long-handled shoehorns
- Specially designed kitchen tools
Chronic pain can be very stressful. Stress can also increase the sensation of pain and its impact on day to day life. Options to help can include:
Surgery may be needed if there is severe damage or loss of function. Option include:
- Replacing a joint—arthroplasty
- Tendon reconstruction
American College of Rheumatology
The Arthritis Society
Canadian Rheumatology Association
Rheumatoid arthritis. Arthritis Foundation website. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis. Accessed June 5, 2018.
Rheumatoid arthritis. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/rheumatoid-arthritis-ra. Updated February 2017. Accessed June 5, 2018.
Rheumatoid arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Rheumatic%5FDisease/default.asp. Updated April 30, 2017. Accessed June 5, 2018.
Rheumatoid arthritis (RA). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115261/Rheumatoid-arthritis-RA . Updated May 2, 2018. Accessed June 5, 2018.
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4/16/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115261/Rheumatoid-arthritis-RA . Zautra AJ, Davis MC, Reich JW, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J Consult Clin Psychol. 2008;76(3):408-421.
1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115261/Rheumatoid-arthritis-RA : Anis A, Zhang W, Emery P, et al. The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Rheumatology (Oxford). 2009;48(10):1283-1289.
1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115261/Rheumatoid-arthritis-RA : Aletaha D, Neogi T, Silman AJ, Funovits J, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580-1588.
- Reviewer: EBSCO Medical Review Board Warren A. Bodine, DO, CAQSM
- Review Date: 05/2018
- Update Date: 05/13/2016