Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints.
© Nucleus Medical Media, Inc.
RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes include: Genes—people with rheumatoid arthritis may have a specific genetic defect that increases their risk for developing this conditionDefects in the immune system may cause the immune cells to fail to recognize the body’s own tissuesInfection with specific viruses or bacteria that kick off an abnormal immune responseChemical or hormonal imbalances in the body
RA is more common in women, and in people between the ages of 30 and 60. Other factors that may increase your chance of developing RA include: Family members with RAExcess weight or obesity
Heavy or long-term
RA usually presents with joint symptoms Symptoms involve 2 or more joints which are usually: Smaller jointsThe same joints on both sides of the bodySymptoms include: Increased pain and stiffness in the morning and after inactivity that lasts more than 30 minutesRed, swollen, warm jointsDeformed, misshapen joints
RA may also cause: Intense fatigue, decreased energyMuscle achesDecreased appetiteWeight lossFever and sweatsInsomniaSmall lumps or nodules under the skin
Inflammation may also occur in EyesMouthSkinLungsBlood and blood vessels
You will be asked about your symptoms and medical history. A physical exam will be done. RA is sometimes difficult to diagnose because there are several diseases with similar symptoms. Part of diagnosing RA is to rule out other diseases.
The American College of Rheumatology and the European League Against Rheumatism have created a system for diagnosing RA. To start, symptoms need to be present for 6 weeks or more. The system then uses a 10-point scale assessing specific symptoms. The higher the score, the more likely RA is present. Considered factors include: The number of swollen or sore joints with any associated damage. This includes both small and large joints. Which joints are affected, how many joints are affected, and for how long they have been affected all help with the diagnosis.Blood tests that look for markers of RA. Specific substances, such as those associated with autoimmunity and inflammation, may be present in the blood.Imaging tests to look at the affected joint and surrounding structures. These may include: X-raysUltrasoundMRI scanTissue samples include: Synovial biopsy—Removing a piece of the synovial membrane that lines the joint capsule.
Arthrocentesis (joint aspiration)—Removal of synovial fluid from the joint with a needle.
There is no cure for RA. The goals of treatment are to: Relieve painReduce inflammationSlow down joint damageImprove functional ability
There are a variety of medications to treat the pain and inflammation of RA. In some cases, medications may be used in combination. These may include: Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, cyclooxgenase-2, or COX-2 inhibitors. They may be applied to the skin or taken by mouth.Disease-modifying antirheumatic drugs (DMARDs) are injected under the skin or taken by mouth. DMARDs include: Nonbiologics suppress the immune system. The most common is nonbiologic DMARD is methotrexate.Biologics attempt to repair, stimulate, or enhance the immune system. Common biologic DMARDs include adalimumab, etanercept, and abatacept.Corticosteroids—injected into the joint (less common)
Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.
These steps may help relieve stiffness, weakness, and reduce inflammation: Maintain a balance between rest and exerciseAttempt mild strength trainingParticipate in aerobic exercise, such as, walking, swimming, or dancingAvoid heavy-impact exerciseControl weightParticipate in a physical therapy program
Splints applied to painful joints may reduce pain. Devices that help with daily activities can also reduce stress on joints. Devices include: Zipper extendersLong-handled shoehornsSpecially designed kitchen tools
can ease the difficulties of living with a chronic, painful disease. Participating in an exercise program or joining a
are 2 strategies you can use to reduce stress.
Cognitive behavioral therapy
, a form of talk therapy, and
may also offer benefits in reducing your pain and improving your ability to cope with RA.
Joint replacement and tendon reconstruction help relieve severe joint damage.
There are no current guidelines to prevent RA.
Rheumatoid arthritis. Arthritis Foundation website. Available at:
http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis. Accessed November 29, 2016.
Rheumatoid arthritis. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/rheumatoid-arthritis-ra. Updated May 2013. Accessed November 29, 2016.
National Institute of Arthritis and Musculoskeletal and Skin Diseases
website. Available at:
http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp. Updated February 2016. Accessed November 29, 2016.
Tanaka E, Saito A, Kamitsuji S, et al. Impact of shoulder, elbow, and knee joint involvement on assessment of rheumatoid arthritis using the American College of Rheumatology Core Data Set.
Arthritis Rheum. 2005;53(3):864-871.
Verstappen SM, Bijlsma JW, Verkleij H, et al. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys.
Arthritis Rheum. 2004;51(3):488-497.
4/16/2009 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed. Zautra AJ, Davis MC, Reich JW, et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression.
J Consult Clin Psychol.
1/4/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Anis A, Zhang W, Emery P, et al. The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study.
1/4/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Aletaha D, Neogi T, Silman AJ, Funovits J, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.
Ann Rheum Dis.
4/24/2014 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, Appel M, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: https://acsearch.acr.org/docs/69424/Narrative. Updated 2013. Accessed May 13, 2016.
Last reviewed November 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.