Introduction to rheumatoid arthritis

Rheumatoid arthritis (RA) is a common type of arthritis, found in over 1.3 million people in the United States. Often debilitating, it’s a painful, chronic disease that damages the joints. The condition usually affects people ages 20 to 60, with women five times more likely than men to have it.

RA typically is thought to occur when the immune system doesn’t work as it should and attacks the membranes, which are the thin tissues that surround the joints. Researchers don’t fully understand why this happens. The result is inflammation that’s often marked by pain, swelling, and stiffness of more than one joint. Unlike osteoarthritis, RA frequently is “symmetrical” in that it affects both sides of the body at once. For example, you may feel pain in both hands and both hips.

Symptoms may vary from person to person. There’s currently no cure for RA. Some people go through cycles in which their RA flares up and is extremely painful, then quiets down, and then returns. Still others have continuous pain for many years. Additional symptoms such as fatigue and fever may accompany the disease.

 

How is rheumatoid arthritis diagnosed?

To make a diagnosis, your health care provider will:

 

  • Ask about your medical history. Be prepared to tell your health care provider about your level of pain, symptoms, current medications, and any other medical issues. The most common sign of RA is joints that are painful, red, swollen, stiff, and/or tender. Your health care provider will also ask about your overall well-being. Let your provider know if you’ve been feeling tired or achy and/or have been experiencing flu-like symptoms.
  • Perform a physical examination. To assess the condition of your joints, your provider will examine your hands, feet, wrists, knees, and hips for inflammation and physical changes. Your provider also will look for small swellings or lumps, known as rheumatoid nodules, near the affected small joints, such as those in your fingers or toes, and for signs of inflammation in other parts of your body.
  • Order laboratory tests and X-rays to confirm the diagnosis. Lab tests and X-rays can be very useful in diagnosing RA. Your health care provider will often order several blood tests to help determine the cause of your joint pain. X-rays, bone scans, and magnetic resonance imaging scans (MRIs) may also reveal swollen tissue around the joints and indicate the severity of the condition.

Your health care provider will arrive at the final diagnosis after reviewing all of the evidence.

Goals of RA treatment

As mentioned, there’s no known cure for RA. But new studies show that people may have better outcomes if the condition goes into remission, which means that there are periods when the RA isn’t actively causing further joint damage. When your RA is in remission, you’ll have no major signs or symptoms of inflammation.

The goals of a medical plan for treating RA will be to:

  • Control pain
  • Reduce inflammation
  • Decrease progression of or stop joint damage
  • Improve your overall health and daily functioning

How is RA usually treated?

The treatment plan for each person is often different. But common treatments usually involve a combination of the following approaches:

  • Joint care: Using a splint for the wrist and hands or the ankles and feet may relieve pain and reduce swelling. Your provider may recommend other short-term aids or devices to help ease discomfort in daily activities.
  • Exercise: Moving your body can sometimes alleviate RA symptoms and improve flexibility, although it can also make the symptoms worse. It is important to talk to your provider about which activities are best for you.
  • Stress reduction: The chronic pain and overall achiness that come with RA can bring on feelings of frustration, anxiety, and anger. Stress can increase the pain and reduce your quality of life. Meditation and support groups can sometimes help with the tension.
  • Diet: A healthy diet can lead to weight loss, which can in turn lessen the pressure on your joints. Foods rich in certain oils may reduce inflammation. Your provider or a nutritionist can help you to assess your diet, put together a healthy and manageable plan, and recommend nutritional supplements.
  • Rest: Taking breaks and getting enough rest can reduce inflammation, pain, and fatigue. At the same time, RA pain can make it difficult to relax. Consult your health care provider if your symptoms interfere with rest, especially sleep.
  • Medication: Your provider likely will recommend drugs to try and slow or even stop the progression of your RA as well as to help you manage pain. You may be instructed to take a combination of over-the-counter and prescription medications. Talk to your provider or pharmacist about possible side effects and how these medications may affect other health conditions you have.
  • Surgery: You and your health care provider will probably only consider surgery if other treatments no longer work and your pain and mobility are getting worse to an intolerable point. A procedure such as joint replacement or tendon reconstruction can decrease pain, improve flexibility, and repair damage.
  • Routine care: Because RA can be unpredictable, it’s important to keep in close contact with your health care team. Together, you’ll be able to assess which treatments are working and to make needed changes along the way.