Rheumatoid arthritis

Overview

In rheumatoid arthritis (RA), the immune system attacks the lining of the joints by mistake. This causes swelling, pain, and stiffness and, over time, can damage the joints and change their shape.

RA usually affects the same joints on both sides of the body. It can also cause fatigue, low fever, and problems in the eyes, lungs, and heart. Getting diagnosed and treated early, ideally within months of symptoms starting, helps protect the joints.

Symptoms

RA often starts slowly.

• Pain and swelling in many joints
• The same joints on both hands or both sides
• Morning stiffness lasting over an hour
• Stiff fingers or hands
• Hand, finger, or wrist pain
• Fatigue

Less common

• Low fever and loss of appetite
• Firm lumps under the skin (rheumatoid nodules)
• Dry eyes and mouth
• Trouble making a fist or buttoning clothes

How it usually goes

• Weeks to months: Stiffness and swelling slowly build.
• Within 6 months: The best time to be diagnosed and start treatment.
• Weeks to months of treatment: DMARDs start to work.

Look up a symptom: Fever

When to get medical care

Causes

RA is an autoimmune disease. Doctors don't know exactly why the immune system attacks the joints. Genes and things like smoking may play a part.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.
• It can run in families. Tell your doctor if a parent, brother, or sister has it.

Who is more likely to get it

• Being female
• Family history of RA
• Smoking

Possible complications

• Anemia: Low red blood cells
• Carpal tunnel syndrome: Swelling can squeeze the wrist nerve
• Joint infection: More likely with RA and its medicines

Diagnosis

There's no single test. A healthcare professional uses your symptoms, an exam, blood tests, and X-rays.

Questions you may be asked

• Which joints hurt and swell, and whether both sides are affected
• How long morning stiffness lasts
• Fatigue, fever, or weight loss
• Family history of RA or other autoimmune diseases

The exam

They'll check joints for swelling, warmth, tenderness, and how well they move.

Tests

Tests may include:

• Blood tests: Rheumatoid factor, anti-CCP antibodies, and markers of inflammation.
• X-rays or ultrasound: To look for joint damage or swelling.

Treatment

Most people with RA take medicine. Starting disease-modifying medicine (DMARDs) early can slow or stop joint damage.

Self-care

• Stay active with gentle exercise like walking, swimming, or biking
• Balance activity with rest, especially during flares
• Use heat for stiffness and cold for swelling
• Don't smoke
• Keep follow-up visits and blood tests

Medicines

RA medicines need a prescription, except some pain relievers.

Pain relievers alone don't stop RA from damaging joints. DMARDs are needed.

If the first medicine doesn't control RA, your rheumatologist may add or switch to other DMARDs, biologics, or JAK inhibitors. Physical and occupational therapy help protect joints. Surgery is sometimes needed for badly damaged joints.

How it compares

Prevention

RA can't always be prevented, but you can protect your joints:

• Don't smoke
• See a doctor early for joint swelling
• Stay active and keep a healthy weight

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a rheumatologist (joint and immune system doctor).
• A physical therapist can help with exercises to rebuild strength and motion.

Living with it

• Stay active with walking, swimming, or biking.
• Keep a healthy weight to ease joint strain.
• Long-term illness can affect mood. Tell your doctor if you feel down or anxious.

Support groups and helplines

• Arthritis Foundation: Helpline, exercise programs, and online community.

Back to school, work, or sports

• Most people can keep working or going to school.
• Ask about changes that help, like extra breaks or a flexible schedule. Workers may be covered by the ADA. Students may get a 504 plan.

Children, pregnancy, and older adults

• Children: Arthritis in children is a different condition (juvenile arthritis); see a specialist.
• Pregnancy: Some RA medicines aren't safe in pregnancy. Plan ahead with your rheumatologist.
• Older adults: Watch for side effects of pain relievers and steroids.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

For caregivers

• Go to visits when you can and take notes.
• Keep a list of medicines, allergies, and doctors in one place.
• Learn the warning signs that need fast care.
• Take breaks and ask for help. Caregivers need care too.

Outlook

RA is lifelong, but treatment keeps improving. With early treatment, many people control symptoms and prevent joint damage.

Myths and facts

Getting ready for your visit

A list of joints and how long stiffness lasts helps.

What to bring

• Which joints are affected and when it started
• How long morning stiffness lasts
• Family history of autoimmune diseases
• All medicines and supplements

Questions to ask

• Do I have RA or another type of arthritis?
• Should I see a rheumatologist?
• Which medicine should I start?
• What exercise is safe for me?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Rheumatoid arthritis