Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that attacks the joints. It's also classified as an inflammatory disorder because RA causes joint swelling. It can strike at any age, and it can come on gradually or rapidly. Hands, wrists, and feet are common targets, although larger joints, such as knees and hips, may be involved later on, as the disease progresses. RA can make you feel fatigued and weak, and sometimes it affects other tissues and organs of the body, causing heart, lung, skin, or eye problems.

There's no cure for rheumatoid arthritis, but there are treatments that can stave off further joint damage and ease the pain of living with this chronic condition. That's why early diagnosis and treatment are so important.

Rheumatoid arthritis is a chronic disease that causes inflammation of the joints, or synovitis. The body's own immune system, for reasons that are still largely unknown, attacks healthy tissue lining the joints. But don't confuse RA with osteoarthritis (OA), the more common type of arthritis stemming from the loss of bone-cushioning tissue that can occur as people age.

With RA, the stiffness you experience tends to be worse upon waking in the morning or after a period of inactivity. It may stubbornly persist for an hour or longer. Another clue that it's RA: As the disease progresses, symptoms arise in a symmetrical pattern. If the joints in your right hand are hurting, it's a good bet that, over time, the pain in your left hand will mimic the right. Symptoms can also extend beyond the joints. RA can sap your energy level and squelch your appetite. The disease may lead to complications that affect other organs and tissues in the body.

Not all cases of rheumatoid arthritis look or behave the same way. Naturally, scientists want to know what's behind the person-to-person differences they observe in RA symptoms, disease progression, and outcomes. So far, they've identified one key distinguishing factor: the presence of certain auto-antibodies (or antibodies that attack the body) in patients' blood.

You might hear doctors talk about these two different types of rheumatoid arthritis:

• Seropositive RA means your blood has anti-cyclic citrullinated peptides (anti-CCPs), also known as anti-citrullinated protein antibodies (ACPAs). The majority of RA patients are seropositive.
• Seronegative RA means you don't have these antibodies in your blood, but you still might have RA.

Pinpointing such differences may one day lead to more targeted treatments.

People with rheumatoid arthritis may see symptoms develop slowly; others experience rapid onset of the disease.

Watch for these RA signs and symptoms:

• Pain or aching in more than one joint.
• Stiffness in more than one joint.
• Tenderness, swelling, and warmth in more than one joint.
• Symptoms on both sides of the body.
• Low-grade fever.
• Weight loss or loss of appetite.
• Fatigue or sleep problems.
• Weakness.

Other tissues and organs, such as the heart, lungs, blood, nerves, eyes, and skin, can be involved. Dry eyes and mouth, for example, can be due to Sjögren's syndrome, an autoimmune disease that can be a complication of RA. Nodules, or lumps, may pop up beneath the skin or in other tissues or organs, such as the lungs. If left untreated or not adequately treated, RA can be disabling, even causing deformities, mostly affecting the hands and feet.

When you have rheumatoid arthritis, your immune system turns on itself, attacking healthy cells by creating a lot of inflammation that harms the joints. That faulty inflammatory response targets synovial tissue, the lining of joints. What scientists don't know is why this happens. But there are genetic, environmental, and lifestyles factors that can boost your risk:

• Being female. Women are twice or three times as likely to be diagnosed with RA than men.
• Inheriting certain genes, including one called HLA-DBR1.
• Smoking.
• Being obese.

One potentially protective factor: Lactation. There's evidence that women who breastfeed may be less likely to develop RA.

It's also common for people with RA to experience symptom flare-ups and other times when symptoms subside or go into remission. Some relapses are unpredictable, while others are brought on by triggers in your environment, such as:

• Emotional stress.
• Physical overexertion.
• Infections.
• Poor sleep.
• Stopping your RA medication.

No single test can confirm a diagnosis of rheumatoid arthritis. The quest for answers usually begins with a physical exam and medical history. Blood tests look for inflammation and antibodies. Imaging tests, such as X-rays, may not detect early changes but can provide a baseline for assessing the progression of the disease.

If you are diagnosed with RA, it's likely that your care team will include a rheumatologist, who specializes in the care of people with arthritis. As with many chronic diseases, the sooner RA is diagnosed and treated, the better. Treatments can slow or stop RA damage, which staves off further joint damage.

Although rheumatoid arthritis is a progressive disease, it can often be managed through medication and self-care strategies. When medications fail, surgery to repair or replace damaged joints may be an option.

Commonly prescribed RA medications:

• Disease-modifying antirheumatic drugs, a category that includes methotrexate and hydroxychloroquine as well as newer biologics like Enbrel (etanercept) and Remicade (infliximab).
• Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen.
• Corticosteroids, such as prednisone.
• Janus kinase inhibitors, such as Xeljanz (tofacitinib).

Self-care strategies:

• Engage in gentle movement and low-impact exercise.
• Take rest breaks and aim for a good night's sleep.
• Maintain a healthy weight.
• Use heat (hot showers or baths) to relax muscles, and cold (ice packs) to ease pain and swelling.
• Apply topical products for pain relief.
• Manage stress. You might try meditation, deep breathing, massage, or other mind/body approaches.
• Consider an omega-3 fatty acid.
• Seek support from friends and family.

Medications can keep rheumatoid arthritis from worsening, but there are no proven interventions for preventing this potentially debilitating disease in the first place. StopRA, the first RA prevention research study in the U.S., is designed to examine whether the drug hydroxychloroquine (already used as an RA treatment) can prevent RA in people who have high levels of anti-CCP in their blood but no joint inflammation (synovitis) or no diagnosis of RA.

Until science yields more answers, the best people can do is manage potential risk factors for RA.

• Quit smoking. Lighting up can boost your risk of developing RA.
• Maintain good oral hygiene. Research suggests a possible link between gum disease and RA.
• Manage stress. It can trigger the body's inflammatory response.

If you have joint pain or other RA symptoms, don't put off seeing your physician. If it's RA, the sooner you start treatment, the better.

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