What is Rheumatoid Arthritis?

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If you are on this website, you either have Rheumatoid Arthritis, think you may have Rheumatoid Arthritis, or someone close to you does. I’m not a medical doctor, obviously, but I have learned a lot about RA and other forms of inflammatory arthritis over the years.  So let’s cover the basics and talk about typical symptoms, causes, diagnosis, and management.

Overview

Rheumatoid arthritis is a systemic autoimmune disease that primarily affects the joints. Unlike osteoarthritis, which is caused by wear and tear on the joints, rheumatoid arthritis is the result of an abnormal immune response. The immune system mistakenly targets the synovium, a thin membrane that lines the joints, leading to inflammation and damage. Over time, this inflammation can also affect other organs and tissues, most commonly the lungs, the heart, kidneys, skin and eyes.  More rarely, RA can also affect the blood vessels, the nervous system and even rarely, the bone marrow.

RA is a serious, systemic disease that can affect people of any age, and can cause significant pain, organ damage and disability.  Early treatment is vital, so its important to know the signs and symptoms and when you should see a doctor.  

Signs and symptoms

The symptoms of rheumatoid arthritis can vary greatly from person to person, and even in the same person, symptoms can vary in severity and fluctuate over time.  For some people, RA is a mild disease, causing painful joints from time to time. For others, RA is a systemic, disabling disease causing constant pain that significantly impacts their function and quality of life.   

The disease often begins in the small joints, such as the hands and feet and can progress to affect the larger joints (e.g. knees, shoulders, hips etc) as the disease progresses. 

Common symptoms of RA include:

  1. Joint pain and stiffness: Persistent pain and stiffness in multiple joints, often worse in the morning or after periods of inactivity.  The affected joints in RA are usually symmetrical, for example, if it affects one wrist, it will also affect the other wrist.
  2. Joint swelling: Swelling and tenderness in the affected joints due to inflammation.  Some people have very little visible swelling, and for others the swelling is very obvious.
  3. Fatigue: RA often causes persistent fatigue and for some, this fatigue is even worse than the pain.  Some believe the fatigue is a function of pain, but it is also results from the body’s immune response and chronic inflammation.
  4. Morning stiffness: Many people with RA experience prolonged morning stiffness, which can last for an hour or more.  This impedes usual daily activities and makes it hard to ‘get going’ in the mornings.  Stiffness and difficulty moving joints, also occurs after long periods of rest.
  5. Joint deformity: Over time, in advanced disease, untreated rheumatoid arthritis can lead to joint deformities and loss of function. 
  6. Systemic symptoms: In some cases, RA can cause systemic symptoms such as fever, weight loss, and dry eyes.
  7. Malaise:  People with RA often experience a general feeling of being unwell. Some people describe it as being like having the flu, all the time.

Causes and risk factors

The exact cause of rheumatoid arthritis remains unknown, but researchers believe that a combination of genetic and environmental factors contributes to its development. Some common risk factors associated with RA include:

  • Genetic predisposition: Certain genetic markers are more prevalent in individuals with rheumatoid arthritis, suggesting a hereditary component.
  • Hormonal factors: Women are more likely to develop RA than men, indicating that hormonal influences may play a role.
  • Smoking: Cigarette smoking has been identified as a significant risk factor for RA, particularly in individuals with a genetic predisposition.
  • Environmental factors: Exposure to certain infections or pollutants may trigger the onset of rheumatoid arthritis in susceptible individuals.
rheumatoid arthritis affecting the hands
Photo by RDNE Stock project on Pexels.com

How is rheumatoid arthritis diagnosed

If you suspect you, or someone you love, has rheumatoid arthritis, its important to be seen by a doctor urgently.  Early diagnosis and treatment has been shown to lead to the best outcomes and minimise damage to joints, and ongoing pain and disability.   Diagnosing RA involves a comprehensive evaluation by a rheumatologist, but in Australia, the first port of call is your GP.  Your GP will take a thorough history, usually order some blood tests, and may order some scans of your joints.  If your GP suspects RA, they will refer you to a rheumatologist who will confirm or rule out a diagnosis of RA.

Diagnosis is based on a combination of factors, and there is no one test that confirms RA.  I still see people saying they had a blood test that showed they have RA.  This is impossible, because RA can’t be diagnosed by blood work alone. 

When diagnosing rheumatoid arthritis (RA), a rheumatologist typically takes a thorough medical history and performs a physical examination. These steps help in assessing symptoms, evaluating joint involvement, and ruling out other possible conditions. Here’s an overview of what to expect during the diagnostic process:History and physical examination

Medical History

Your rheumatologist will ask detailed questions about your symptoms, including joint pain, stiffness, swelling, and duration of symptoms. They will also inquire about any family history of arthritis or autoimmune diseases, past medical conditions, previous treatments, and any other relevant information.

Symptom Assessment

Your rheumatologist will inquire about the specific joints affected, the pattern of joint involvement (symmetrical or asymmetrical), the duration and progression of symptoms, morning stiffness, and any associated symptoms such as fatigue or systemic manifestations.

Physical examination

Your rheumatologist will conduct a physical examination to evaluate the joints, assess their range of motion, and check for signs of inflammation (e.g., swelling, warmth, tenderness). They may also examine other areas of the body, including the skin, eyes, lungs, and cardiovascular system, to identify any extra-articular manifestations associated with RA.

Blood tests

To support the diagnosis, the rheumatologist may order blood tests to measure certain markers and antibodies that are commonly associated with RA. These tests may include:

  • Rheumatoid factor (RF): An antibody that is present in about 70-80% of people with RA.
  • Anti-cyclic citrullinated peptide (anti-CCP) antibodies: These antibodies are more specific to RA and are present in a significant proportion of individuals with the disease.
  • Acute phase reactants: Blood tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) help assess the level of inflammation in the body.
  • Complete blood count (CBC): This test provides information about red and white blood cells and can help detect anemia, which can be associated with RA.

It’s important to remember that none of these blood tests can be used to make a conclusive diagnosis of RA, but are used as part of a holistic assessment.

Scans

X-rays, ultrasound, or magnetic resonance imaging (MRI) may be ordered to evaluate joint damage, inflammation, and assess the extent of disease involvement.  Most people have x-rays taken on diagnosis, to be used as a bench-mark as time goes on and measure treatment success and/or joint damage.

Diagnostic criteria

Your rheumatologist will consider the results of the medical history, physical examination, and laboratory tests in the context of established diagnostic criteria for RA. The most commonly used criteria are the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. 

It’s important to remember that diagnosing RA can be complex, and the process may vary depending on the individual case. Some people are ‘textbook’ cases, and diagnosis is quick and relatively simple.  Most, however, have a varying combination of signs and symptoms, and especially in early disease, it can be hard to be sure that its really RA, or one if its many immitators.  Often, people are given an ‘umbrella’ diagnosis like “inflammatory polyarthritis’ which means they know it’s a type of inflammatory arthritis, its affecting multiple joints, but they aren’t sure if its RA, or one of the other inflammatory arthritis type, such as psoritatic arthritis, or axial spondyloarthritis. 

Rheumatologists are trained to evaluate and diagnose rheumatic conditions, and they consider multiple factors to arrive at an accurate diagnosis. If you suspect you may have RA, it’s recommended to consult a rheumatologist for a comprehensive evaluation and diagnosis.

How is rheumatoid arthritis treated

While there is no cure for rheumatoid arthritis, several treatment options aim to manage symptoms, slow down disease progression, and improve the quality of life for individuals with RA. The aim is to get the disease into remission, and early intervention is crucial to prevent the progression of disease and minimize long term damage to joints and other compilations.

The treatment plan usually involves a multidisciplinary approach, including medications, physical therapy, lifestyle modifications, and surgery in advanced disease. Common treatment options include:

Medications

Medications play a key role in managing rheumatoid arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. Disease-modifying antirheumatic drugs (DMARDs) are prescribed to slow down the progression of RA and protect the joints. Biologic response modifiers, a type of DMARD, target specific components of the immune system to reduce inflammation. Corticosteroids may be used to provide short-term relief during flare-ups.

bDMARDs

Biologic response modifiers: Biologic drugs target specific components of the immune system involved in the inflammatory response. They are often recommended for individuals who do not respond adequately to conventional DMARDs.

DMARDs

Disease-modifying antirheumatic drugs (DMARDs): These medications help slow down the progression of rheumatoid arthritis by suppressing the immune response and reducing inflammation. Methotrexate is commonly prescribed as a first-line DMARD.

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs provide temporary relief from pain and inflammation associated with rheumatoid arthritis. However, they do not alter the course of the disease.

Corticosteroids

Corticosteroids are powerful anti-inflammatory medications, and they can feel like ‘magic’ in how quickly they reduce inflammation and pain. They come with very serious side effects, however, and therefore they should only be prescribed for short periods to rapidly control a ‘flare up’.  Some people, with serious disease that does not respond to other treatments, take corticosteroids long term. In this circumstance, it is always the goal to take the lowset possible dose.

Pain medication  – simple analgesics

Simple analgesics or over-the-the-counter pain medications, such as acetaminophen paracetamol (acetaminophen), can be used to relieve mild to moderate pain in RA. They do not have anti-inflammatory properties but can help with pain management.

Pain medication – opioids

Opioid medications, such as codeine or oxycodone, may be prescribed for severe pain that is not adequately controlled by other pain medications.  Rheumatoid arthritis can cause severe pain, and no other medications help for severe pain other than opioids. Its important to remember that opioids do carry the risk of dependence, though this risk is low when people are properly educated in the safe use of opioid and take the as prescribed.  Like corticosteroids, ideally opioids would only be needed occasionally and for short periods, but the reality is that some people have severe pain every day, and opioids do provide a safe and effective way to manage that pain, when well-monitored.

Topical gels and creams

Topical pain relievers, such as creams or gels containing nonsteroidal anti-inflammatory drugs (NSAIDs) or capsaicin, can be applied directly to the affected joints and provide good  localized pain relief.

Physiotherapy

A physiotherapist can help improve strength and maintain joint function by prescribing a range of exercise including:

  • Range-of-motion exercises: Help maintain joint flexibility and reduce stiffness.
  • Strengthening exercises: Strengthen the muscles around the affected joints for better support.
  • Low-impact aerobic exercises: Improve cardiovascular health and overall fitness without putting excessive strain on the joints.

Hydrotherapy

Water-based exercises, performed in a warm pool, can relieve joint stiffness and pain while providing a low-impact environment for physical activity. The buoyancy of water reduces stress on the joints and allows for greater range of motion.

Surgery

Surgery is only recommended in advance RA, where there is significant damage to the joints, causing pain and disability.  These surgeries aim to alleviate pain, improve joint function, and correct deformities caused by the disease. Here are a few surgical options for RA:

Synovectomy

A synovectomy involves the removal of the inflamed synovial lining of a joint affected by RA. It is most commonly performed in the wrist, but can also be done in other joints such as the knee. Synovectomy helps reduce pain and inflammation and may slow down joint damage progression.

Joint replacement surgery

In severe cases where joint damage is extensive and causing pain and disability, joint replacement surgery is an option. This involves removing the damaged joint surfaces and replacing them with artificial joints made of metal, plastic, or ceramic materials. Total joint replacement is commonly done for hips and knees, but it can also be performed on other joints such as the shoulders, elbows, and ankles.

Tendon repair

Rheumatoid arthritis can cause tendon damage and rupture, leading to joint instability and loss of function. In some cases, surgical repair of the affected tendons may be necessary to restore joint stability and improve function.

Fusion surgery

Fusion surgery involves fusing the bones of the affected joint together to create a stable joint, eliminating pain and reducing deformity. Fusion surgery is most commonly performed in the spine, wrists, and ankles.

Occupational therapy

Occupational therapy (OT) can help people with rheumatoid arthritis (RA) by providing strategies and interventions to manage symptoms, improve daily functioning, and enhance overall quality of life. OT focuses on joint protection techniques, teaching individuals how to protect their joints during activities, as well as modifying activities to make them more manageable. OT can provide splints and recommend adaptive equipment to support and stabilize affected joints, while also teaching pain management techniques to cope with RA-related pain. Additionally, OT can help individuals with RA make necessary modifications to their work environment, recommend adaptive strategies for leisure activities, and empower individuals to regain independence and engage in meaningful activities despite the challenges posed by the disease.

Complimentary therapies

Complementary therapies for rheumatoid arthritis (RA) encompass a range of approaches that can be used alongside conventional medical treatments to support symptom management and overall well-being. Among these therapies are techniques such as acupuncture, which involves the insertion of thin needles at specific points on the body to stimulate healing and relieve pain. Massage therapy utilizes various techniques to relax muscles, improve circulation, and reduce joint stiffness. Mind-body practices like yoga and tai chi incorporate gentle movements, stretching, and breathing exercises to enhance flexibility, strength, and mental relaxation. Additionally, some individuals may consider the use of dietary supplements such as fish oil, turmeric, or ginger, which are believed to possess anti-inflammatory properties. It is important to note that while these complementary therapies can provide additional support, they should not replace or be relied upon as sole treatments, and it is advisable to consult with healthcare professionals before incorporating them into an RA management plan.

Self-management and Lifestyle modifications

While the taking medications prescribed by a rheumatologist are at the core of treating rheumatoid arthritis, there is a lot a person with RA can do to improve their quality of life, and increase their chances of reaching remission.  There are a number of lifestyle changes people with RA can make inclduing

Exercise

Engaging in regular physical activity helps maintain joint mobility, strengthen muscles, and improve overall fitness. Low-impact exercises such as walking, swimming, and cycling are generally the best options for RA but the best exercise is the one you enjoy and are likely to do regularly.

Sleep

Sleep disturbances are common in RA. Establishing a regular sleep routine, creating a comfortable sleep environment, and practicing good sleep hygiene can contribute to better rest and overall energy levels.

Diet and nutrition

No matter what some people post on the internet, dietary changes CANNOT cure RA, and for most people make no difference to symptoms.  But maintaining a well-balanced diet can support overall health. Including a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats can provide essential nutrients and support optimal body functioning.

Maintain a healthy weight

Maintaining a healthy weight helps reduce stress on joints and can alleviate symptoms. A dietitian or nutritionist can develop a healthy eating plan  tailored to your needs and food preferences.

Stress management

Stress can exacerbate RA symptoms and cause flare ups. Practicing stress management techniques such as deep breathing, meditation, mindfulness, and engaging in activities that promote relaxation (e.g., hobbies, spending time in nature) can help reduce stress and enhance well-being.

Quitting smoking

Smoking has been linked to an increased risk of RA development and can worsen symptoms. Quitting smoking can contribute to overall health improvement and potentially reduce RA symptoms.

Social Support

Connecting with others who have RA or joining support groups can provide emotional support, information sharing, and coping strategies. Engaging in social activities and maintaining a strong support network can positively impact mental well-being.

Can I prevent rheumatoid arthritis?

Unfortunately, it is not possible to prevent the development of rheumatoid arthritis (RA). RA is a complex autoimmune disease with multifactorial causes, and while certain risk factors such as genetics and environmental factors may contribute to its development, there is no known method to prevent its onset.

However, early diagnosis and appropriate treatment can help manage symptoms, slow down disease progression, and improve quality of life.  So if you have concerns, or have symptoms that might be RA, especially if you have a family history or autoimmune disease, it is recommended to consult with a healthcare professional for proper evaluation and guidance.

What are common complications of RA?

Rheumatoid arthritis (RA) is a chronic autoimmune disease that can lead to a range of complications affecting various organs and systems in the body. These complications include joint damage and deformity, the development of rheumatoid nodules, increased risk of osteoporosis and fractures, cardiovascular disease, lung complications, eye involvement, heightened susceptibility to infections, and emotional and mental health challenges. Managing RA effectively requires close monitoring and comprehensive care to address these complications, reduce inflammation, preserve joint function, and promote overall well-being. Collaboration with healthcare professionals is vital to develop an individualized treatment plan that addresses both the joint-related symptoms and the potential systemic effects of RA.

How will rheumatoid arthritis affect me?

Rheumatoid arthritis (RA) is a highly individualized disease, impacting each person differently in terms of disease severity, affected joints, and associated complications. Its unpredictable nature makes it challenging to forecast the exact progression of the disease. While some individuals may experience mild symptoms and minimal joint involvement, others may face more aggressive disease activity, significant joint damage, and systemic manifestations. However, by closely adhering to the guidance of a rheumatologist and following the prescribed treatment plan, individuals can optimize their chances of achieving remission or low disease activity. This typically involves a combination of medications, lifestyle modifications, and regular monitoring to tailor the treatment approach to each person’s specific needs. Active involvement in managing RA, along with regular communication and collaboration with healthcare providers, is key to promoting better outcomes and enhancing overall quality of life.

When to see a doctor

Symptoms that warrant a doctor’s appointment if you suspect you have rheumatoid arthritis (RA) include persistent joint pain, swelling, and tenderness, particularly in the small joints of the hands, wrists, feet, or ankles. Other indicators are morning stiffness lasting over an hour, limited joint mobility, fatigue, general malaise, and joint redness. Systemic symptoms like low-grade fever, weight loss, and loss of appetite may also be present.

Because early treatment is crucial for the best treatment outcomes, it is important to seek care as soon as possible.  In Australia, the first step is to consult your GP, who will assess whether your symptoms are likely to be due to rheumatoid arthritis. And if necessary refer you to a rheumatologist who will confirm or rule out RA.

Seeking medical attention for evaluation and diagnosis is important when experiencing these symptoms to receive appropriate care and management, because RA, when left untreated can cause significant pain, loss of quality of life, and disability.  Treated early,   most people can achieve remission, or low disease activity, but your best chance is early, aggressive treatment.

Finding support

Finding support for rheumatoid arthritis (RA) is crucial for managing the condition effectively. There are various avenues to seek support, including rheumatology clinics, support groups (both in-person and online), arthritis foundations and organizations, online communities, counselling and therapy, friends and family, physical and occupational therapists, patient advocacy groups, educational workshops and webinars, and online resources.

These resources provide a range of support, including medical guidance, emotional support, practical tips, education, and connection with others facing similar challenges. It is important to explore different options and create a personalised support network that suits your needs, as a combination of professional guidance, peer support, and the understanding of loved ones can greatly contribute to managing RA and improving overall well-being.

Conclusion

In conclusion, rheumatoid arthritis is a chronic autoimmune disease that affects the joints, causing pain, swelling, and reduced mobility. While there is no cure, a combination of medications, lifestyle modifications, and complementary therapies can help effectively manage the condition and improve quality of life. By understanding the symptoms, causes, and available treatment options, individuals with rheumatoid arthritis can take proactive steps towards managing their condition and achieving better health and well-being.

Remember, rheumatoid arthritis is a ‘heterogenous’ disease, meaning it varies greatly in how it affects different people.  One person may have flares that occur once a month which forces them to get an early night.  Another person may have flares weekly, which make it impossible to go to work, or even get out of bed. Still others live with constant pain and inflamed joints with no reprieve of symptoms or pain. It is rarely helpful to compare, but support from others who live with RA can make you feel understood and less alone.

Of course, it is always essential to consult with a healthcare professional for personalized advice and guidance tailored to your specific needs. Stay informed, stay proactive, and take control of your rheumatoid arthritis journey.

FAQs

  1. Is rheumatoid arthritis the same as osteoarthritis?

    Rheumatoid arthritis (RA) is not the same as osteoarthritis. While both conditions affect the joints, they have different underlying causes. RA is an autoimmune disease where the immune system mistakenly attacks the joints, leading to inflammation and joint damage. Osteoarthritis, on the other hand, is a degenerative joint disease primarily caused by wear and tear on the joints over time.

2. Can rheumatoid arthritis go into remission?

Yes, rheumatoid arthritis can go into remission. Remission in RA refers to a state where the disease activity is minimal or absent, and symptoms are well-controlled. Achieving remission often requires early and aggressive treatment with medications, such as disease-modifying antirheumatic drugs (DMARDs) and biologics. However, it’s important to note that remission is not a cure, and ongoing monitoring and management are necessary to maintain the remission state.

3. Is rheumatoid arthritis hereditary?

Rheumatoid arthritis has a hereditary component, but it is not solely determined by genetics. Having a family history of RA can increase the risk of developing the condition, but only by a very small factor and it does not guarantee that an individual will develop RA. Environmental factors, such as smoking, certain infections, and hormonal factors, are also believed to play a role in the development of RA.

4. Are there any natural remedies that can help with rheumatoid arthritis?

There are NO natural remedies that can cure rheumatoid arthritis. Period.

There are many treatments and therapies and books sold online that promise a cure, but none of these have any evidence of anything other than emptying your wallet.

However, some natural or complementary therapies may provide additional symptom control when used alongside conventional medical treatments.  Remember, these are called “complimentary therapies” because they complement medical treatment, not be used instead of medicines. Complementary treatments that can improve quality of life include practices such as regular exercise, physical therapy, occupational therapy, acupuncture, mind-body techniques like meditation and yoga, and certain dietary changes and supplements. It’s important to discuss these options with a healthcare professional to ensure they are safe and appropriate for your specific situation.

5. Can rheumatoid arthritis affect children?

Yes, rheumatoid arthritis can affect children, and it is known as juvenile idiopathic arthritis (JIA). JIA is the most common form of arthritis in children. It is characterised by joint inflammation, similar to RA in adults. The symptoms, treatment approaches, and prognosis of JIA may differ from adult-onset RA. Paediatric rheumatologists specialize in diagnosing and managing JIA in children.

6. How does rheumatoid arthritis impact daily life?

Rheumatoid arthritis can have a significant impact on daily life. It can cause joint pain, stiffness, swelling, and reduced mobility, which can affect one’s ability to perform daily activities, such as dressing, grooming, and household tasks. Fatigue, decreased energy levels, and the potential for systemic symptoms can also impact overall quality of life. Managing RA often requires medication management, lifestyle modifications, and regular medical appointments, and individuals may need to adapt their routines and seek support to cope with the physical and emotional challenges of the disease.

7. Can rheumatoid arthritis be cured?

Currently, there is no known cure for rheumatoid arthritis. However, with early diagnosis, appropriate treatment, and ongoing management, it is possible to control symptoms, prevent joint damage, and achieve remission. Treatment aims to reduce inflammation, relieve pain, preserve joint function, and improve quality of life. Collaborating with a rheumatologist and following the prescribed treatment plan, which may include medications, physical therapy, and lifestyle modifications, can help manage the disease effectively.

8. What is the role of a rheumatologist in treating rheumatoid arthritis?

Rheumatologists play a crucial role in the treatment of rheumatoid arthritis. These specialized doctors diagnose and manage various rheumatic diseases, including RA. They are trained to evaluate symptoms, order relevant tests, and develop personalized treatment plans. Rheumatologists work closely with patients to monitor disease activity, adjust medications, and provide guidance on managing symptoms and preventing complications. They may also collaborate with other healthcare professionals, such as physical therapists and occupational therapists, to optimize care and improve quality of life for individuals with RA.

3 COMMENTS

  1. I’ve had RA for 10 years and like most men with this disease, I was totally lost. Most of the advice I received others with RA was worse than useless but the advice you provided has been good. Perhaps you should considering doing RA group meetings on zoom or something, I’d definitely pay.

    • Thanks Rick! I’m writing some informational content, more formal style, to build a writing portfolio and hopefully get some paid work 🙂 Hope you’re doing well!

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