Rheumatoid arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a long-term (chronic) disease that causes inflammation of the joints. The inflammation can be so severe that it affects how the joints and other parts of the body look and function. In the hand, RA may cause deformities in the joints of the fingers. This makes moving your hands difficult. Lumps, known as rheumatoid nodules, may form anywhere in the body.

Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger. It causes inflammation and joint stiffness that last for more than 6 weeks. Unlike adult RA, which lasts a lifetime, children often outgrow JRA. But the disease can affect bone development in a growing child.

What causes rheumatoid arthritis?

The exact cause of RA is not known. RA is an autoimmune disorder. This means the body's immune system attacks its own healthy cells and tissues. This causes inflammation in and around the joints. This may damage the skeletal system. RA can also damage other organs, such as the heart and lungs. Researchers think certain factors, including heredity, may be a factor.

RA most often occurs in people from ages 30 to 50, but it can occur at any age. It happens more in women than in men.

What are the symptoms of rheumatoid arthritis?

The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease often causes inflammation in the same areas on both sides of the body. Symptoms may begin suddenly or slowly over time. Each person’s symptoms may vary, and may include:

• Pain
• Stiffness, especially in the morning
• Swelling over the joints
• Decreased movement
• Pain that is worse with joint movement
• Bumps over the small joints
• Trouble doing activities of daily living (ADLs), such as tying shoes, opening jars, or buttoning shirts
• Trouble grasping or pinching things
• Tiredness and lack of energy (fatigue)
• Occasional fever

These symptoms can seem like other health conditions. Always see your healthcare provider for a diagnosis. 

How is rheumatoid arthritis diagnosed?

Diagnosing RA may be difficult in the early stages. This is because symptoms may be very mild, and signs of the disease may not be seen on X-rays or in blood tests. Your healthcare provider will take your medical history and give you a physical exam. Tests may also be done, such as:

• X-ray. This test uses a small amount of radiation to create images of internal tissues, bones, and organs onto film.
• Joint aspiration. For this test, a small fluid sample is taken from a swollen joint. It is done to look for signs of infection or gout.
• Nodule biopsy. Tiny tissue samples are taken to look at under a microscope. This helps to check for cancer or other abnormal cells.   
• Blood tests. These tests are done to find certain antibodies, called rheumatoid factor, cyclic citrullinated antibody, and other signs of RA.
• Ultrasound or MRI. These imaging tests can look for bone damage and inflammation. 

How is rheumatoid arthritis treated?

Your healthcare provider will figure out the best treatment for you based on:

• How old you are
• Your overall health and medical history
• How sick you are
• How well you handle certain medicines, treatments, or therapies
• If your condition is expected to get worse
• Your opinion or preference

There is no cure for RA. The goal of treatment is often to limit pain and inflammation, and help ensure function. You may have 1 or more types of treatments. Treatment may include:

• Medicines. Some medicines may be used for pain relief. Some are used to treat inflammation. Others can help to slow the disease from getting worse. Medicines should be managed by a rheumatologist. This is a doctor who specializes in arthritis and rheumatic diseases. You may need regular blood tests to check how the medicines affect your blood cells, liver, and kidneys.
• Splints. Splints may be used to help protect the joints and strengthen weak joints.
• Physical therapy. Physical therapy may be used to help increase the strength and movement of the affected areas.

In some cases, surgery may be an option if other treatments don’t work. Surgery does not cure RA. It helps correct the deformities caused by the disease. After surgery, RA can still cause problems. You may even need more surgery. Joint repair or reconstruction can be done in many ways, including:

• Surgical cleaning. This surgery removes inflamed and diseased tissues in the hands to help increase function.
• Joint replacement (arthroplasty). This type of surgery may be used in cases of severe arthritis of the hand. It may be done on older adults who are not so active. Joint replacement may reduce pain and help increase joint function. During the surgery, a joint that has been destroyed by the disease is replaced with an artificial joint. The new joint may be made out of metal, plastic, or silicone rubber. Or it may be made from your own tissue, such as a tendon from another part of your body.
• Joint fusion. For this surgery, a joint is removed, and the two ends of bones are fused together. This makes one large bone without a joint. This is usually done on patients with advanced RA. After the bone fusion, the fused joint can’t move.