Rheumatoid Arthritis 101

Rheumatoid arthritis (RA) is a chronic autoimmune condition in which the immune system attacks your joints — specifically the joint lining called the synovium. When the synovium becomes inflamed, it leads to symptoms of pain, swelling and stiffness.

While RA most often affects the joints, it can also damage other areas of the body like the skin, eyes, blood vessels, heart and lungs.

RA can start out in the small joints of the hands and feet, but as the condition progresses, symptoms can affect larger joints like the wrists, elbows, hips, knees and ankles.

You might notice:

• Joints that are swollen, painful and warm
• Joint stiffness in the mornings or after you’ve been resting
• Poor appetite
• Feeling tired or weak
• Fever

Usually, these symptoms show up in the same joints on each side of the body. As with other immune conditions, RA symptoms come on suddenly (known as a flare-up) and then get better (known as remission).

Genetics and gene changes may contribute more than half to a person's risk of developing RA. People with a change in the human leukocyte antigen (HLA) gene might be more at risk of RA.

Certain risk factors might trigger you to develop RA, which can include:

• Smoking tobacco products
• Exposure to occupational hazards like dust or fibers
• A family history of RA
• Being overweight or obese
• Certain infections

If RA symptoms aren’t treated, it can affect other parts of the body and lead to concerns such as:

• Deformed joints
• Viral infections, from a decreased immune system
• Dry eyes
• Dry mouth
• Carpal tunnel syndrome when swelling presses against the nerves in the hands and fingers
• Osteoporosis, where bones become weak and more prone to fractures
• Heart disease
• Lung disease
• Lymphoma, a cancer of the lymphatic system

There isn’t a single test that can diagnose RA. Instead, your clinician may have you see a rheumatologist, a doctor specializing in autoimmune and joint conditions. They will do a physical exam and ask you questions about your symptoms and medical history.

Blood tests that can look for inflammation might include an erythrocyte sedimentation rate (ESR) or “sed rate” and C-reactive protein (CRP). Other blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies that attack joints.

Imaging tests like X-ray, MRI or ultrasound look for joint inflammation and damage.

RA treatments aim to do two things: decrease pain and swelling, and slow down or prevent joint damage. Beginning treatment early may better protect you from the long-term damage RA can cause.

Often, clinicians will start you on one or more medications. These might include:

• Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, leflunomide and hydroxychloroquine. DMARDs are usually the first treatment option to control swelling and protect joints from deformity.
• Janus kinase (JAK) inhibitors such as tofacitinib and upadacitinib — a newer, more targeted form of DMARD that block inflammation to reduce joint pain and damage.
• Biologics such as abatacept, adalimumab and etanercept block inflammation signals to the joints.
• Corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) for short-term pain and swelling management.

Physical or occupational therapy exercises help keep your joints moving, improve fatigue and manage pain.

Surgery can also be used to restore movement in joints that have been damaged. This could be surgery to fix a deformity, or a hip or knee replacement.

While treatments such as medications and surgery help manage RA symptoms, there are things you can do at home as well.

Low-impact physical activity like walking or swimming helps to increase or maintain muscle strength around joints. Doing repetitive movements like deep bending at the knees can cause joint injuries, so avoid them as much as possible.

An anti-inflammatory diet (similar to the Mediterranean diet) might help reduce inflammation in joints and lower the risk of heart disease for people with RA. This includes unprocessed foods, fruits and vegetables, omega-3 fatty acids, whole grains, and reduced sugar.

Maintain a healthy weight, which can decrease inflammation and pain, and if you smoke, try to quit.

While you may not be able to fully prevent RA, you can take steps to reduce the risk. By beginning treatment right away, you can decrease the long-term damage to joints and help control swelling and pain.