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Rheumatoid Arthritis: Symptoms, Causes, Treatment, and More

Rheumatoid arthritis affects more than 1.3 million people in the United States and is 2.5 times more common in females compared to males.

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disease that targets joints and causes pain, swelling, and stiffness. Autoimmune conditions occur when the immune system attacks healthy cells in the body instead of foreign invaders like viruses or bacteria. Unlike the wear and tear damage to the cartilage of the joint in osteoarthritis, rheumatoid arthritis attacks the lining of joints. The joint’s lining becomes inflamed when attacked, leading to joint damage, chronic pain, and deformity. The most common joints affected are the hands, wrists, and knees. With rheumatoid arthritis, the joints affected are symmetrical, so the same joints on both sides of the body are usually symptomatic. The inflammation present with rheumatoid arthritis may also affect other tissues in the body and cause symptoms in the skin, eyes, heart, blood vessels, and lungs.

Summary: Rheumatoid arthritis is an autoimmune condition that affects the joints in the body causing pain, swelling, and stiffness. The most common joints affected are the hands, wrists, and knees.

Types of Rheumatoid Arthritis

Rheumatoid arthritis is divided into three different types: seropositive rheumatoid arthritis, seronegative rheumatoid arthritis, and juvenile rheumatoid arthritis. The different types of rheumatoid arthritis dictate how severe the symptoms of the disease are and the course of treatment.

  • Seropositive Rheumatoid Arthritis: seropositive rheumatoid arthritis is diagnosed when blood tests are positive for the presence of a protein called rheumatoid factor. This protein indicates that the body is producing an immune response to normal tissues. Studies have shown that over 80% of people with rheumatoid arthritis test positive for rheumatoid factor 1.
  • Seronegative Rheumatoid Arthritis: people who have blood tests that are negative for the presence of rheumatoid factor are referred to as seronegative. People who test negative for rheumatoid factor are more likely to have a mild form of rheumatoid arthritis compared to those who test positive.
  • Juvenile Rheumatoid Arthritis: juvenile rheumatoid arthritis is the most common type of arthritis that affects children ages 16 or younger. It has the same symptoms as rheumatoid arthritis in adults including swelling of the joints, pain, and deformity.

Stages of Rheumatoid Arthritis

Rheumatoid arthritis affects every person differently, though the disease generally progresses through four stages. There is no exact timeline for the progression of rheumatoid arthritis, but without effective treatment, the condition tends to worsen over time. Each stage of rheumatoid arthritis comes with different treatment goals and medications are designed to slow the progression of rheumatoid arthritis (2).

  • Stage One: stage one is the earliest and most mild stage of rheumatoid arthritis. Many people start to feel joint pain, stiffness, or swelling in this stage. There is usually inflammation in one or more joints causing the joint to swell. There is no damage to the bones making up the joint, but the joint lining becomes inflamed.
  • Stage Two: stage two is considered moderate rheumatoid arthritis. The inflammation in the joint lining starts to damage the joint cartilage. Cartilage covers the end of bones making up the joints and protects the bone surface from becoming damaged during joint movement. When cartilage becomes damaged it causes symptoms of pain and loss of range of motion.
  • Stage Three: when rheumatoid arthritis progresses to stage three it is considered severe. Damage to the joint extends through the cartilage to the bones and causes them to rub together during joint movement. There is typically more pain and swelling in this stage. Many people have muscle weakness due to inactivity since it is painful to move. With bone damage, mobility is lost and deformity may occur.
  • Stage Four: stage four is end-stage rheumatoid arthritis. People in this stage experience pain, swelling, stiffness, and mobility loss. The joints are destroyed at this stage and the bones become fused together so the joints no longer work. Muscle atrophy occurs due to not being able to move the joints.

Progression through all four stages can take many years and may not happen for every person diagnosed with rheumatoid arthritis. Some people have periods of time where there is no disease activity, which is called remission, though most people with rheumatoid arthritis experience a gradual worsening of symptoms.

Summary: Rheumatoid arthritis is a progressive condition and if not treated, symptoms tend to get worse. The disease affects each person differently, though rheumatoid arthritis typically progresses through four stages. Mild symptoms occur early in the disease process and it can progress to symptoms of joint deformity and complete loss of range of motion.

Symptoms of Rheumatoid Arthritis

The hallmark signs of rheumatoid arthritis are pain and inflammation in the joints. The most common joints affected are the hands, wrists, and knees. Symptoms occur at the same joint on both sides of the body in a symmetrical pattern. Rheumatoid arthritis can also affect tissues and organs due to chronic inflammation including the lungs, heart, and eyes.

Symptoms of rheumatoid arthritis affecting the joints can include:

  • Pain in more than one joint
  • Swelling, warmth, and redness in more than one joint
  • Stiffness, especially first thing in the morning or after a period of stillness
  • Loss of joint function
  • Loss of range of motion and reduced ability to move the joints
  • Joint deformity

Symptoms of rheumatoid arthritis affecting other tissues and organs can include:

  • Fatigue and lack of energy
  • Low-grade fever
  • Loss of appetite and weight loss
  • Weakness
  • Sweating
  • Dry eyes
  • Rheumatoid nodules – firm lumps which form under the skin around affected joints in around 20% of people with rheumatoid arthritis (3)

There are times when symptoms of rheumatoid arthritis get worse which are known as flares. There are also times when symptoms get better or even disappear, which is known as remission.

 

Summary: Rheumatoid arthritis most commonly affects the joints causing pain and inflammation. Other frequent symptoms include fatigue, low-grade fever, and loss of appetite.

Causes and Risk Factors of Rheumatoid Arthritis

The exact cause of rheumatoid arthritis is unknown. Research supports that genetics, hormones, and environmental factors all can contribute to the risk of developing rheumatoid arthritis (4). Rheumatoid arthritis occurs when the immune system starts attacking the joints. An infection, smoking, or a prolonged stressful situation may trigger immune system dysfunction.
There are several risk factors for developing rheumatoid arthritis including:

  • Family history: if you have a close relative that has been diagnosed with rheumatoid arthritis you are more likely to develop the disease. Researchers have found specific genes that are linked to rheumatoid arthritis.
  • Sex: females are 2-3 times more likely to develop rheumatoid arthritis.
  • Hormones: some hormonal changes appear to be linked to rheumatoid arthritis. Those changes may include both during and after pregnancy, breastfeeding, and the use of oral contraception.
  • Age: rheumatoid arthritis can be diagnosed at any age, though the risk does increase with age. The most common ages to be diagnosed with rheumatoid arthritis are between 40 and 60 years.
  • Smoking: smoking not only increases the risk of developing rheumatoid arthritis but also makes the disease symptoms and progression worse. It is the strongest environmental risk factor for the development of rheumatoid arthritis.
  • Environment: infection can trigger rheumatoid arthritis in those that have a genetic susceptibility.
  • Obesity: people who are obese have a higher chance of developing rheumatoid arthritis.

Diagnosis of Rheumatoid Arthritis

The first step to treating rheumatoid arthritis is getting an accurate diagnosis as soon as possible after symptoms start. A doctor who specializes in treating arthritis is called a rheumatologist and is the best person to make a correct diagnosis. The diagnosis is usually made using a combination of medical history, physical examination, lab tests, and imaging.

Medical History and Physical Examination 

The doctor will take a full medical history with special attention to joint symptoms such as pain, tenderness, stiffness, or loss of range of motion. Questions will include when the joint symptoms started, how long they last at a time, how severe they are, and what makes the symptoms increase or decrease. A family history will also be taken since having a family member with rheumatoid arthritis or other autoimmune disorders can increase the risk of developing the disease.

During the physical examination, the doctor will look for signs of inflammation in the symptomatic joints such as tenderness, swelling, and warmth. The doctor will examine how much range of motion occurs in each joint and will ask about pain during motion. The doctor will also observe any bumps that may be under the skin around the joints and will take vital signs including temperature.

Blood Tests

The blood tests for rheumatoid arthritis look for general inflammation and specific antibodies, or blood proteins, linked to rheumatoid arthritis.

  • Erythrocyte Sedimentation Rate (ESR): the ESR blood tests measures how quickly red blood cells settle in a test tube. Inflammation can lead to extra proteins in the blood which makes the red blood cells settle faster. A higher ESR means that there is inflammation in the body, though it does not indicate where the inflammation is coming from.
  • C-reactive Protein (CRP): a CRP test measures how much C-reactive protein is in the blood. CRP is released into the bloodstream by the liver in response to inflammation, so a higher CRP level indicates higher inflammation levels. Doctors can use this test to monitor the level of disease activity, but like ESR, this test does not indicate where the inflammation is coming from (5).
  • Rheumatoid Factor (RF): rheumatoid factor is an antibody found in around 80% of people with rheumatoid arthritis. Rheumatoid factors are proteins produced by the immune system that can attack healthy tissues in the body. High levels of rheumatoid factor indicate autoimmune diseases. such as rheumatoid arthritis.

Imaging Tests

Doctors might use imaging tests such as X-rays, ultrasounds, or MRIs to help confirm the diagnosis of rheumatoid arthritis. Rheumatoid arthritis may cause joint damage which will show up on these scans. It is possible for someone with rheumatoid arthritis to have negative imaging tests if it is in an early stage and has not affected the joint tissue yet. Imaging tests may not only be used for diagnosing but can also show how well treatments are working.

Summary: Your doctor will take into consideration your medical history, physical examination, lab work, and imaging tests to make a diagnosis of rheumatoid arthritis. The most common tests include blood work and imaging such as x-rays and/or MRIs.

Treatment Options for Rheumatoid Arthritis

The goals of treatment for rheumatoid arthritis include reducing inflammation to the lowest level possible, relieving symptoms, preventing joint and organ damage, and improving overall well-being. Doctors that treat rheumatoid arthritis usually use early and aggressive treatment to reduce inflammation as quickly as possible (6). Usually remission, or a resolution of symptoms, is the goal of treatment.

Medication

Arthritis medications play an essential role in controlling the symptoms of rheumatoid arthritis and the progression of the disease. Early treatment, which might involve one or several medications, is usually recommended to halt the disease progression. There are many different classes of drugs that are used to treat rheumatoid arthritis.

  • Disease Modifying Anti-Rheumatoid Drugs (DMARDs): DMARDs are one of the most important drugs in treating rheumatoid arthritis and work to slow or stop the progression of the disease. These drugs work by suppressing the immune system and lead to fewer symptoms and less damage over time.
  • Biologics: biologics are a class of DMARDs that are taken by injection. They block specific inflammatory pathways which reduces the inflammation caused by rheumatoid arthritis.
  • Glucocorticoids (Steroids): steroids are powerful anti-inflammatory medications and can reduce the symptoms of rheumatoid arthritis. Steroids can also reduce the pain and damage caused by inflammation. They are not recommended for long term use due to side effects.
  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs are among the most commonly prescribed medications for rheumatoid arthritis. Unlike other classes of painkillers, NSAIDs tend to be more effective for rheumatoid arthritis since they also prevent inflammation.
  • Analgesics (Painkillers): Analgesics are very effective at reducing pain that can be caused by the disease process in rheumatoid arthritis. Prescription painkillers are typically only used for severe pain caused by rheumatoid arthritis since they can lead to dependence. Painkillers also do not work to stop the progression of the disease or reduce inflammation.

Lifestyle Factors

Rheumatoid arthritis affects nearly every aspect of daily life including work, leisure, and social life. There are several lifestyle changes that are proven to increase the quality of life in those with rheumatoid arthritis. These measures, when combined with rheumatoid arthritis medications, can help to manage symptoms of the disease.

Exercise

Getting regular physical activity can reduce the risk of developing complications from rheumatoid arthritis such as heart disease, diabetes, and depression. The American College of Sports Medicine recommends that adults get 150 minutes of moderate-intensity exercise (something that gets the heart rate elevated) per week. This could include many forms of physical activity to accommodate joint swelling or pain, such as swimming or biking. Exercise should be broken up into 30 minutes a day on 5 days each week and can be further broken up into three 10-minute segments a day if needed (7).

Incorporating physical activity into your daily routine is a good way to make sure you are getting enough movement during the day. Some strategies can include taking the stairs instead of the elevator and parking in the back of the lot to encourage more walking.

Stress Management

Many studies show the connection between stress and health issues, including autoimmune disease. There are many different ways to relax and reduce stress which may ease disease flares. Easy stress management techniques include meditation, deep breathing, and thinking of images or memories that produce happiness. Yoga is an effective way to incorporate meditation, breathing, and introducing movement into a daily routine. Tai chi is also a good option for those with rheumatoid arthritis and the slow, mindful breaths and movements have a positive effect on mood-regulating hormones. Massage and acupuncture can reduce pain, relax sore muscles, and reduce stress.

Diet

An anti-inflammatory diet has been shown to reduce the symptoms of autoimmune diseases, such as rheumatoid arthritis. Foods that contain omega-3s have been well-studied for their anti-inflammatory effects and eating omega-3s on a regular basis can decrease disease activity. The best sources of omega-3s include fatty fish, seaweed, hemp seeds, flaxseed oil, chia seeds, walnuts, and edamame. High-antioxidant fruits and vegetables can help to reduce oxidative stress from chronic inflammation. The best sources of antioxidants are dark berries, dark leafy greens, nuts, and dried ground spices. High-fiber whole grains such as whole wheat, brown rice, and quinoa have also been linked to reducing chronic inflammation. 

Along with eating anti-inflammatory foods, it is also important to avoid foods that contribute to higher inflammation levels. The most inflammatory foods include red meat, dairy, processed foods, and alcohol.

Quitting Smoking

Research suggests that smoking is a risk factor for rheumatoid arthritis. Cigarette smoke also has a negative effect on the immune system and can increase inflammation in the body. Increased inflammation can make the symptoms of rheumatoid arthritis worse. Cigarette smoke has also been shown to reduce the effectiveness of some medications used to treat rheumatoid arthritis (8).

Summary: Treatment options for rheumatoid arthritis include medications and lifestyle factors. There are several different classes of drugs that are used to treat rheumatoid arthritis. Lifestyle factors to consider include exercise, diet, and stress management.

Complications of Rheumatoid Arthritis

Rheumatoid arthritis increases the risk of developing several other conditions. Not only does the disease process of rheumatoid arthritis increase your risk for complications, but the medications that are commonly used to treat rheumatoid arthritis can also increase your risk.

  • Osteoporosis: being diagnosed with rheumatoid arthritis increases your risk of developing osteoporosis, which is a condition that weakens your bones. Medications that treat rheumatoid arthritis can also increase the risk of developing osteoporosis. Due to bones being weaker, people with osteoporosis have an increased risk for fracture.
  • Sjogren’s Syndrome: people with rheumatoid arthritis have an increased risk of developing Sjogren’s syndrome which is a disorder that decreases the amount of moisture in the eyes and mouth (9).
  • Rheumatoid Nodules: rheumatoid arthritis causes firm bumps of tissue to form around pressure points, such as the elbow. Though these nodules can form anywhere in the body, including tissues such as the heart and lungs.
  • Infections: autoimmune conditions such as rheumatoid arthritis impair the immune system. Many medications that treat rheumatoid arthritis also reduce the ability of the immune system to fight infections. People with rheumatoid arthritis need to protect themselves with vaccinations to prevent diseases such as the flu, pneumonia, shingles, and COVID-19.
  • Carpal Tunnel Syndrome: when rheumatoid arthritis affects the wrist joints, the increased inflammation can compress the median nerve that innervates most of the hand and fingers. This causes symptoms of carpal tunnel such as numbness, tingling, and pain in the hand.
  • Heart Disease: the disease process of rheumatoid arthritis increases the risk of heart disease. This may include hardened and blocked arteries and pericarditis which is a painful inflammation of the sac that encloses the heart. Atherosclerosis, or hardened arteries, is the leading cause of death in those with rheumatoid arthritis. People with rheumatoid arthritis are advised to stop smoking and maintain a healthy weight to reduce the risk of premature heart disease.
  • Lung Disease: people with rheumatoid arthritis have an increased risk of pulmonary fibrosis, a disease that causes scarring in the tissues of the lung. Symptoms of pulmonary fibrosis include shortness of breath, dry cough, fatigue, and aching muscles and joints.
  • Eye Disease: dry eyes is a common complaint in those diagnosed with rheumatoid arthritis. Mild pain and severe redness of the eye, known as episcleritis, may also occur.
  • Lymphoma: having rheumatoid arthritis may increase the risk of lymphoma which are cancers that start in the lymph system. Symptoms of lymphoma include weight loss, fatigue, and enlarged lymph nodes.
  • Obesity: the ratio of fat to lean mass is often higher in people who have rheumatoid arthritis, even in those with normal body weight. People with rheumatoid arthritis who are obese have an increased risk of developing heart disease and diabetes. Obesity also reduces the prognosis of a good result from medical treatment compared to those at a healthy body weight (10).
  • Vasculitis: rheumatoid vasculitis is characterized by inflammation of small blood vessels of the skin, fingers and toes, nerves, eyes, and heart. When blood vessels become inflamed they may become weakened or blocked and cause other serious complications.
  • Costochondritis: when rheumatoid arthritis affects the joint that connects the ribs to the sternum, it is known as costochondritis. The condition is very painful and can feel like you are having a heart attack due to the location of the joints affected on the front of your chest.
  • Sexual Dysfunction: studies suggest that 31 to 76% of people with arthritis experience sexual dysfunction. Causes may include the symptoms of rheumatoid arthritis such as pain, fatigue, and stiffness. Hormone imbalance and depression may also play a role.

Summary: There are several possible complications in people diagnosed with rheumatoid arthritis. The complications can affect the heart, lungs, bones, and eyes among other tissues in the body.

Conclusion

Rheumatoid arthritis is an autoimmune disease that causes joint swelling, pain, and stiffness. The most common joints affected are the hands, wrists, and knees and symptoms occur in a symmetrical pattern. Rheumatoid arthritis can also affect other tissues in the body such as the heart, lungs, and skin. Typically people with rheumatoid arthritis are diagnosed between the ages of 40 and 60 years old and women are 2-3 times more likely to be diagnosed compared to men.

The diagnosis of rheumatoid arthritis is made by a rheumatologist who will consider your medical history, blood tests, and imaging results. Treatment options include both medication and lifestyle factors. Lifestyle changes such as quitting smoking, exercising, and reducing stress can assist in reducing the symptoms of rheumatoid arthritis. It is important to seek early and aggressive treatment to slow or stop the progression of rheumatoid arthritis to avoid the risk of complications from the disease. If you feel you have the symptoms of rheumatoid arthritis, consult your healthcare provider to learn more about your options today.