Rheumatoid arthritis (RA) can result in a very severe form of arthritis (though this is not always the case; sometimes it can be mild). It is a chronic, disabling disorder that can cause a multitude of physical woes, including eventual destruction of the joints and cartilage throughout the body. It can also affect the lungs, muscles, blood vessels, skin, and heart.
Rheumatoid arthritis is an autoimmune disorder. Disorders of this nature result when the body initiates an immunological response to protect itself against something mistakenly recognized as foreign.
The joint damage caused by RA begins with inflammation of a layer of tissue called synovium that lines the joints. The inflammation leads to a thickened synovial membrane owing to an overgrowth of synovial cells and an accumulation of inflammatory cells called white blood cells. The release of enzymes and other substances by these cells can erode the cartilage that lines the joints, as well as the bones, tendons, and ligaments within the joint capsule. As the disease progresses, the production of excess fibrous tissue limits joint motion. Inflammation of tissue surrounding affected joints can also contribute to joint damage.
Less common than osteoarthritis, rheumatoid arthritis affects 1 in every 100 people, with women two to three times more likely to be affected than men. Between 1995 and 2007, the incidence of rheumatoid arthritis increased modestly in American women but not men, for reasons that aren’t entirely clear. Some proposed reasons include the obesity epidemic, low vitamin D levels, and use of oral contraceptives with lower levels of estrogen than in the past (high levels of estrogen may protect against RA, though this is still being investigated). Rheumatoid arthritis can start at any age, but onset is most common among people in their sixties.
Fortunately, not everyone who has this disease is severely affected. Many people with RA experience only minor symptoms.
Symptoms of rheumatoid arthritis
• Early symptoms (prior to obvious joint involvement) are generally nonspecific and include fatigue and weakness, low-grade fever, loss of appetite, weight loss, and numbness and tingling in the hands.
• Red, swollen, painful joints, most often those of the fingers, wrists, knees, ankles, and toes on both sides of the body. (This symmetrical pattern and inflammation differentiates it from osteoarthritis. Also, rheumatoid arthritis, unlike osteoarthritis, usually spares the joints nearest the fingertips.)
• Tender joints, warm to the touch.
• Stiffness, especially after awakening in the morning; usually improves during the day.
• Red, painless skin lumps (rheumatoid nodules) on the elbows, ears, nose, knees, toes, or back of the scalp.
• Bent and gnarled joints (with long-term rheumatoid arthritis).
• Chest pain, breathing difficulty (advanced cases).
What causes it?
The exact cause of RA is unknown, but genetic factors clearly play a role.
Since women are more likely to develop RA than men, experts believe hormones may play a role as well.
Cigarette smoking, especially long-term smoking, is also a strong risk factor for developing rheumatoid arthritis, especially in people with a family history of the condition.
What if you do nothing?
Rheumatoid arthritis is generally progressive, and early diagnosis and treatment is important to slow or stop the progression and control the symptoms. If the disease progresses and is not treated, it may severely restrict the range of motion of the affected joints, or worse, destroy the joints altogether.
Home remedies for rheumatoid arthritis
There is no cure for RA at present. The best chance for relieving symptoms requires seeing your doctor (preferably a rheumatologist, a doctor who specializes in diseases of the joints) as soon as possible to develop a treatment plan—and then taking an active role in your treatment. This means maintaining a medication schedule, exercise program, and other therapy recommended by your physician. Educating yourself about the disease is also very helpful. In addition, the following self-care measures can bring relief.
• Try hot or cold packs. Depending upon which temperature feels better, apply a hot or cold pack to a stiff or painful joint.
• Get plenty of rest. Sleeping 8 to 10 hours a night is optimal. Resting during the day is also helpful. When your joints feel warm, swollen, and painful, cut back on physical activity.
• Perform range-of-motion exercises. To maintain joint mobility, perform light exercises that will help preserve the mobility in the painful joint.
• Exercise gently and regularly. The gentle movement of regular exercise is an effective therapy for RA. Walking and swimming are excellent activities to help maintain joint flexibility and strengthen supporting muscles (but let your physician or physical therapist outline your program). The key to a successful program is to find a balance between exercise and adequate rest.
• Ease the strain on painful joints. Make use of devices (such as an electric can opener, larger pens, grab bars in the shower, and other assistive devices) that lend support or minimize joint involvement. A special splint for the hand or wrist can be useful in protecting an injured joint and relieving pain (check with your doctor).
Can rheumatoid arthritis be prevented?
At present, there is no known way to prevent rheumatoid arthritis.
When to call your doctor
Contact your physician if persistent joint pain or stiffness develops, especially if it begins to interfere with daily activities. Also contact your physician if you have RA and new symptoms develop.
What your doctor will do
There is no specific diagnostic test for rheumatoid arthritis. Your doctor will take a careful history and then perform a physical examination of the joints, heart, and lungs. Blood tests may be done and x-rays may also be taken; synovial fluid may be drawn from affected joints and analyzed. If your medical history or the tests are positive, treatment will begin immediately.
A range of medications is available that can reduce or prevent joint damage and preserve joint function. Disease-modifying antirheumatic drugs, or DMARDs, such as adalimumab (Humira) and methotrexate (Trexall), are typically prescribed as early as possible for anyone diagnosed with RA. Your doctor will likely want to follow up with you closely to monitor how you are responding to the medication and whether you’re experiencing any complications from it. NSAIDs or steroids may also be prescribed until the DMARDs provide adequate relief.
Your doctor or a physical therapist will also advise you about an exercise program. For severe cases, physical therapy may be prescribed, and surgery may be recommended for people with severe joint damage.
For more information
Also see Osteoarthritis: Causes and Treatments.