Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disorder in which the immune system attacks healthy joint tissues, causing inflammation, pain, and swelling. It affects about 1 in 200 adults worldwide and is more common in women. RA often begins in small joints, such as those of the hands and feet, and usually involves the same joints on both sides of the body.

Causes and risk factors

  • Genetic predisposition

    Certain HLA class II genes increase risk; family history of RA raises likelihood.

  • Environmental triggers

    Smoking, air pollution, silica dust, and certain infections may initiate the disease.

  • Hormonal and demographic factors

    RA is 2–3 times more common in women; most diagnoses occur between ages 40 and 60.

  • Other factors

    Obesity and periodontal disease have been linked to increased RA risk.

Symptoms

  • Tender, warm, swollen joints
  • Morning stiffness lasting more than 30 minutes
  • Fatigue, low-grade fever, and loss of appetite
  • Joint deformity and loss of function over time
  • Extra-articular features: rheumatoid nodules, dry eyes, lung or heart inflammation

Diagnosis

  • Clinical evaluation

    Medical history and physical exam of joint swelling, symmetry, and range of motion.

  • Blood tests

    Rheumatoid factor (RF), anti-CCP antibodies, ESR, and CRP to assess inflammation and autoimmunity.

  • Imaging

    X-rays, ultrasound, or MRI to detect joint erosion and synovial inflammation.

  • Exclusion of other conditions

    Rule out lupus, gout, psoriatic arthritis, and other mimickers.

Treatment

Medications

  • NSAIDs (ibuprofen, naproxen) for pain relief
  • Corticosteroids (prednisone) to reduce acute inflammation
  • DMARDs (methotrexate, sulfasalazine, hydroxychloroquine) to slow disease progression
  • Biologics (TNF inhibitors, IL-6 inhibitors, B-cell and T-cell targeted agents) for moderate to severe RA
  • JAK inhibitors (tofacitinib, baricitinib) for patients not responding to other DMARDs

Non-drug therapies

  • Physical therapy to maintain joint mobility and muscle strength
  • Occupational therapy to adapt daily activities and protect joints
  • Exercise programs focusing on low-impact aerobic activity
  • Use of heat and cold to relieve stiffness and pain

Surgery

  • Synovectomy to remove inflamed joint lining
  • Tendon repair for damaged tendons around joints
  • Joint fusion or replacement for severely damaged joints

Lifestyle and home care

  • Balanced diet with omega-3 fatty acids to reduce inflammation
  • Stress management techniques (yoga, meditation)
  • Quitting smoking to improve treatment response
  • Regular monitoring by a rheumatologist to adjust therapy

Sources

  • National Center for Complementary and Integrative Health. Rheumatoid arthritis: In depth. Accessed Apr. 10, 2024.
  • American College of Rheumatology. Rheumatoid arthritis. Accessed Apr. 10, 2024.
  • Arthritis Foundation. Rheumatoid arthritis: Causes, symptoms, treatments and more. Accessed Apr. 10, 2024.
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid arthritis: Diagnosis, treatment, and steps to take. Accessed Apr. 10, 2024.