Rheumatoid Arthritis

Rheumatoid arthritis is a type of arthritis in which your body's immune system attacks healthy tissue in your joints. This makes the joints swollen, stiff, and painful. Over time, it may destroy the joint tissues and make it hard for you to walk and use your hands.

Education Topics

Activity

How can exercise help with rheumatoid arthritis (RA)?

Exercise can reduce pain and improve function in people who have RA. It may also help prevent the buildup of scar tissue. This can lead to weakness and stiffness. Exercise for arthritis takes three forms:

Stretching.

Stretching involves moving joint and muscle groups through and slightly beyond their normal range of motion and holding them in position for at least 15 to 30 seconds.

Strengthening.

Strengthening involves moving muscles against some resistance. Strengthening exercise helps people who have RA stay more active and able to do their daily activities. It even seems to help their outlook.

Conditioning.

Conditioning exercise improves aerobic fitness. It may help reduce pain and help you stay more active. Even moderate activity, such as walking, can improve your health and may prevent disability from RA.

Be sure to follow your doctor's advice about your exercise program.

How can exercise help rheumatoid arthritis (RA)?

Exercise can reduce pain and improve function in people who have RA. It may also help prevent the buildup of scar tissue that can lead to weakness and stiffness. Exercise for RA involves stretching the joint and muscle groups, strengthening the muscles, and improving aerobic fitness.

Course

What happens when you have rheumatoid arthritis (RA)?

RA usually progresses slowly, over months or years. RA mostly affects the joints. But it can also cause problems in the eyes, lungs, heart, blood vessels, muscles, and nerves. If the disease progresses it can cause lasting disability. But early treatment may control it and keep it from getting worse.

Definition

Rheumatoid arthritis (RA)

Rheumatoid arthritis is a type of arthritis in which your body's immune system attacks healthy tissue in your joints. This makes the joints swollen, stiff, and painful. Over time, it may destroy the joint tissues and make it hard for you to walk and use your hands.

Medicine may help control rheumatoid arthritis or keep it from getting worse.

Diagnostics

How is rheumatoid arthritis (RA) diagnosed?

To diagnose RA, your doctor looks at a combination of your symptoms and test results. Your doctor will ask you questions about your symptoms and look at your joints for signs of tenderness or swelling.

Diet

How can you care for yourself with a rheumatoid arthritis (RA) diet?

  • Try to eat at least 2 servings of fish each week. Oily fish, which contain omega-3 fatty acids, include:
    • Tuna.
    • Salmon.
    • Mackerel.
    • Lake trout.
    • Herring.
    • Sardines.
  • If you’re pregnant, talk to your doctor about eating fish. Pregnant women shouldn’t eat certain types of fish that have high mercury content.
  • You can get calcium and vitamin D by drinking milk fortified with vitamin D. Four glasses of milk a day provide about 1,200 milligrams (mg) of calcium. Other common foods with calcium:
    • Yogurt (plain or low-fat). An 8-ounce serving provides 415 mg of calcium.
    • Cheddar cheese. A 1½-ounce serving provides 306 mg.
    • Milk (skim, 2%, or whole). A 1-cup serving provides about 300 mg.
    • Cottage cheese (1% milk fat). A 1-cup serving provides 138 mg.
  • If you can’t eat or drink dairy foods, you can get calcium and vitamin D from:
    • Calcium-fortified orange juice. A 1-cup serving provides 500 mg of calcium.
    • Calcium-enriched soy milk. A 1-cup serving provides 282 mg of calcium.
    • Almonds. A 1-ounce serving (about 24 nuts) provides 75 mg of calcium.
    • Canned salmon. A 3-ounce serving provides 180 mg of calcium.
    • Tofu (firm, made with calcium sulfate). A ½-cup serving provides 204 mg.
  • You may need to take a calcium supplement to make sure you are getting the calcium you need.

Rheumatoid arthritis (RA) diet: Overview

The best diet for people with rheumatoid arthritis is a healthy, balanced diet. This is one that is low in saturated fat and salt and high in fiber and complex carbohydrate (whole grains, beans, fruits, and vegetables).

Fish oil (omega-3 fatty acids) has a modest effect in reducing inflammation, and eating fish may improve symptoms.

People who have rheumatoid arthritis have a high risk of developing osteoporosis. To help prevent this disease, get plenty of calcium and vitamin D.

How It Affects You

How does rheumatoid arthritis affect joints?

The ongoing inflammation caused by rheumatoid arthritis affects the tissues that line joints. It causes a breakdown in cartilage and loosens ligaments and tendons that support the joints. The resulting joint destruction can lead to deformed joints.

The pain, stiffness, fatigue, and whole-body (systemic) symptoms of rheumatoid arthritis can be disabling. Over time, the deformity caused by the disease can lead to difficulty with daily activities. Specific joint problems may also occur later in the course of the disease.

The hands and wrists and feet may be deformed. The hands are the most common location for deformities.

Inflammation of the knees, if not controlled by treatment, can cause erosion of cartilage and can later lead to the need for knee replacement surgery.

Rheumatoid arthritis can also damage the cervical spine, or neck. This damage can limit how easily you can move your neck. In rare cases, the damage can pinch a nerve or affect the spinal cord and cause numbness, pain, weakness, or paralysis in the arms or legs.

Medication Therapy

How are medicines used to treat rheumatoid arthritis (RA)?

Medicines are the main treatment for RA. The medicines used depend on how severe your RA is, how fast it's progressing, and how it affects your daily life. Medicines are used to relieve or reduce pain and inflammation, improve daily function, and prevent or delay serious joint damage and deformity.

Overview

Rheumatoid arthritis (RA): Overview

Arthritis is a common health problem in which the joints are inflamed. There are many types of arthritis. In rheumatoid arthritis, the body’s own immune system attacks the joints. This causes pain, stiffness, and swelling in the joints, especially in the hands and feet. It can become hard to open jars, write, and do other daily tasks. Sometimes rheumatoid arthritis can also cause bumps to form under the skin.

Over time, rheumatoid arthritis can damage and deform joints. Early treatment with medicines may reduce your chances of having a lasting disability.

Risk Factors

What increases your risk for rheumatoid arthritis?

Things that may increase your risk for rheumatoid arthritis include:

  • Being female. Rheumatoid arthritis affects women 2 to 3 times as often as men.
  • Being middle-aged. Rheumatoid arthritis can begin at any age, but it most often begins in adulthood.
  • Smoking cigarettes.

Self-care Treatment

How can you care for yourself when you have rheumatoid arthritis (RA)?

  • If your doctor recommends it, get more exercise. Walking is a good choice. If your knees or ankles hurt, try riding a stationary bike or swimming.
  • Move each joint gently through its full range of motion once or twice a day.
  • Rest joints when they are sore or overworked. Short rest breaks may help more than staying in bed.
  • Reach and stay at a healthy weight. Regular exercise and a healthy diet will help you do this. Extra weight can strain the joints, especially the knees and hips, and make the pain worse. Losing even a few pounds may help.
  • Get enough calcium and vitamin D to help prevent osteoporosis, which causes thin bones. Talk to your doctor about how much you should take.
  • Protect your joints from injury. Do not overuse them. Try to limit or avoid activities that cause joint pain or swelling. Use special kitchen tools and other self-help devices as well as walkers, splints, or canes if needed.
  • Use heat to ease pain. Take warm showers or baths. Use hot packs or a heating pad set on low. Sleep under a warm electric blanket.
  • Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Take an active role in managing your condition. Set up a treatment plan with your doctor, and learn as much as you can about rheumatoid arthritis. This will help you control pain and stay active.

Self-care Treatment Options

Caring for yourself when you have rheumatoid arthritis (RA)

Living with RA often means making changes to your lifestyle. You can do things at home, such as staying active and taking medicines, to help relieve your symptoms and prevent the disease from getting worse. Here are some ways that you can care for yourself.

  • Make time to rest.

    RA causes fatigue. And the strain of dealing with pain and limited activities also can make you tired. The amount of rest you need depends on how bad your symptoms are.

    • With severe symptoms, you may need long periods of rest. You might need to rest a joint by lying down for 15 minutes several times a day. Try to find a balance between daily activities that you must do or want to do and the amount of rest you need to do those activities.
    • Plan your day carefully, and include rest periods. Pace your activities so that you don't get overtired.
  • Protect your joints.

    You may need to change the way you do certain activities so that you are not overusing your joints. Try to find different ways to relieve your joint pain.

    • Joint pain and stiffness may improve with heat therapy, such as:
      • Taking warm showers or baths after long periods of sitting or sleeping.
      • Soaking hand joints in warm wax baths.
      • Sleeping under a warm electric blanket.
    • Use assistive devices to reduce strain on your joints. Examples are special kitchen tools or doorknobs.
    • Choose the right shoes that fit well and will not cause joint problems.
    • Use splints, canes, or walkers to reduce pain and improve function.
  • Stay active.

    Keep moving to keep your muscle strength, flexibility, and overall health.

    • Physical therapy may be recommended by your doctor.
    • Exercise for arthritis takes three forms—stretching, strengthening, and conditioning. Exercise can improve or maintain quality of life for people who have RA. Your specific joint problem may guide the type of activity that will help the most. For example:
      • Swimming is a good activity if you have joint problems in your knees, ankles, or feet.
      • Bicycling and walking are good activities if your joint problems are not in your legs or feet.
  • Avoid smoking.

    People with RA have an increased risk of plaque in the arteries (atherosclerosis). Smoking increases this risk even more. Smoking may also lower your response to treatment. So, if you smoke, quit.

  • Eat healthy foods.

    Try to eat a variety of healthy foods. Dietary needs are not the same for all people who have RA. To be sure you get the nutrients you need, you can ask a registered dietitian to help you make a plan.

    • Be sure to get enough calcium and vitamin D to protect your bones against osteoporosis.
    • Lose weight, if you are overweight.
    • People who have rheumatoid arthritis also have an increased risk of heart disease. But healthy lifestyle changes, such as exercise and a healthy diet, may reduce your risk.
  • Take care of your teeth and gums.

    People who have RA tend to get gum disease. You can help prevent gum disease through good basic dental care.

How can you care for yourself when you have rheumatoid arthritis (RA)?

Living with RA often means making changes to your lifestyle. You can do things at home, such as staying active and taking medicines, to help relieve your symptoms and prevent the disease from getting worse.

You can also plan for those times when the disease symptoms may be more severe. It is important to work closely with your health professionals, who may include a physical therapist or counselor, to find ways to reduce pain.

Here's are some ways that you can care for yourself.

Rest

RA causes fatigue. And the strain of dealing with pain and limited activities also can make you tired. The amount of rest you need depends on how bad your symptoms are.

  • With severe symptoms, you may need long periods of rest. You might need to rest a joint by lying down for 15 minutes several times a day. Try to find a balance between daily activities that you must do or want to do and the amount of rest you need to do those activities.
  • Plan your day carefully, including rest periods. Pace your activities so that you don't get overtired.

Protect your joints

You may need to change the way you do certain activities so that you are not overusing your joints. Try to find different ways to relieve your joint pain.

  • Joint pain and stiffness may improve with heat therapy, such as:
    • Taking warm showers or baths after long periods of sitting or sleeping.
    • Soaking hand joints in warm wax baths.
    • Sleeping under a warm electric blanket.
  • Use assistive devices to reduce strain on your joints, such as special kitchen tools or doorknobs.
  • Choose the right shoes that fit well and will not cause joint problems.
  • Use splints, canes, or walkers to reduce pain and improve function.

Stay active

Keep moving to keep your muscle strength, flexibility, and overall health.

  • Physical therapy may be recommended by your doctor.
  • Exercise for arthritis takes three forms—stretching, strengthening, and conditioning. Exercise can improve or maintain quality of life for people who have RA. Your specific joint problem may guide the type of activity that will help the most. For example:
    • Swimming is a good activity if you have joint problems in your knees, ankles, or feet.
    • Bicycling and walking are good activities if your joint problems are not in your legs or feet.

Avoid smoking

People with RA have an increased risk of plaque in the arteries (atherosclerosis). Smoking increases this risk even more. Smoking may also lower your response to treatment. So, if you smoke, quit.

Eat healthy foods

Try to eat a variety of healthy foods. Dietary needs are not the same for all people who have RA. To be sure you get the nutrients you need, you can ask a registered dietitian to help you make a plan.

  • Be sure to get enough calcium and vitamin D to protect your bones against osteoporosis.
  • Lose weight, if you are overweight.
  • People who have rheumatoid arthritis also have an increased risk of heart disease. But healthy lifestyle changes, such as exercise and a healthy diet, may reduce your risk.

Take care of your teeth and gums

People who have RA tend to get gum disease. You can help prevent gum disease through good basic dental care.

Signs and Symptoms

What are the symptoms of rheumatoid arthritis (RA)?

Symptoms in the joints

RA mostly affects the joints. But it can also cause problems in other parts of your body.

Joint pain can be an early symptom of many different diseases. In RA, symptoms often develop slowly over a period of weeks or months. Fatigue and stiffness are usually early symptoms. Weight loss and a low-grade fever can also occur.

Joint symptoms include:

  • Pain, stiffness, and swelling in the joints of the hands, wrists, elbows, feet, ankles, knees, or neck. The disease usually affects both sides of the body at the same time. In rare but severe cases, it may affect the eyes, lungs, heart, nerves, or blood vessels.
  • Morning stiffness. Joint stiffness may develop after long periods of sleeping or sitting. It usually lasts at least 1 hour and often up to several hours.
  • Bumps (nodules). Rheumatoid nodules ranging in size from a pea to a mothball form in nearly one-third of people who have RA. Nodules usually form over pressure points in the body such as the elbows, knuckles, spine, and lower leg bones.

Symptoms in the neck

When RA affects the joints of the neck, especially the joints at the top of the spine, the bones and joints may dislocate and press on the spinal cord or on the nerve roots. This pressure can cause:

  • Neck pain, along with weakness, numbness, or tingling of hands, feet, legs, or arms. This is the most common symptom.
  • Loss of bowel or bladder control.
  • Unusual head and neck sensations.

Pressure on the spinal cord and nerve roots may obstruct blood flow through the blood vessels in the spinal cord. This compression of the spinal cord is fairly rare. But it can lead to being paralyzed if it's not treated.

Other symptoms

Along with specific joint symptoms, RA can cause symptoms throughout the body (systemic). RA can cause problems in the:

  • Eyes. Inflammation of the surface of the eye may cause a dry, gritty-feeling or pain in the eyes.
  • Lungs. Inflammation of the membrane sac around the lungs may cause pain and trouble breathing.
  • Heart. Thickening and inflammation can occur in the sac around the heart, the heart muscle, and the heart valves. This can cause chest pain and shortness of breath.
  • Blood and blood vessels. Low levels of white blood cells and red blood cells and a swollen spleen may occur. Inflammation can affect the blood vessels, causing open skin sores. People with RA seem to develop atherosclerosis earlier than people who don't have RA.
  • Nerves and muscles. There may be a loss of strength in muscles next to affected joints. Inflammation may also cause pressure on the nerves.

People with RA may also have fatigue, loss of appetite, weight loss, and a mild fever.

How does rheumatoid arthritis (RA) affect your body?

Rheumatoid arthritis (RA) mostly affects the joints. But it can also affect the whole body, causing what are called systemic symptoms. These symptoms occur most often in people who have severe disease.

RA can cause problems in the:

Eyes.

Inflammation of the surface of the eye (scleritis) may cause dry, gritty-feeling eyes or pain in the eyes.

Lungs.

Inflammation of the membrane sac around the lungs may cause pain and trouble breathing. Bumps (nodules) may also form in lung tissue.

Heart.

Inflammation can occur in the sac around the heart (pericarditis) and in the heart muscle (myocarditis). Infection can occur in the heart valves (endocarditis).

Blood and blood vessels.

Low levels of white blood cells (leukopenia) and red blood cells (anemia) as well as spleen enlargement may occur. (The spleen is an organ involved in making blood and immune cells.) When these problems occur together, it's called Felty's syndrome. Inflammation can also affect the blood vessels (vasculitis). This can cause open sores (ulcers) of the skin. And people who have RA seem to get plaque deposits in arteries (atherosclerosis) earlier than people who don't have RA.

Nerves and muscles.

There may be a loss of strength in muscles next to affected joints. Inflammation may also cause pressure on the nerves (compression). An example is compression of one of the nerves in the wrist, which affects sensation in the thumb, index, and middle fingers. This is called carpal tunnel syndrome.

What are the symptoms of rheumatoid arthritis in the neck?

When rheumatoid arthritis affects the joints of the neck, especially the joints at the top of the spine, the bones and joints may dislocate and press on the spinal cord or on the nerve roots. This pressure can cause:

  • Neck pain, along with weakness, numbness, or tingling of hands, feet, legs, or arms. This is the most common symptom.
  • Loss of bowel or bladder control.
  • Unusual head and neck sensations.

Pressure on the spinal cord and nerve roots may also obstruct blood flow through the blood vessels in the spinal cord. This compression of the spinal cord is fairly rare. But it can lead to paralysis if it's not treated.

Surgical Treatment

How is surgery used to treat rheumatoid arthritis (RA)?

Surgical treatment for RA is used to relieve severe pain and improve function of severely deformed joints that don't respond to medicine and physical therapy.

Surgery options include:

  • Arthroplasty. This replaces part or all of a joint, such as the hip or knee. It can be done for many different joints in the body. How well it works depends on which joint is replaced.
  • Arthroscopy. This uses a small lighted tool to remove debris or inflamed tissue from a joint.
  • Carpal tunnel release. It relieves pressure on the median nerve in the wrist.
  • Cervical spinal fusion. It treats severe neck pain and nerve problems.
  • Finger and hand surgeries. They correct joint problems in the hand.
  • Foot surgery. An example is phalangeal head resection.
  • Synovectomy. It removes inflamed joint tissue.

Treatment Options

How is rheumatoid arthritis (RA) treated?

RA is most often treated with medicine. Physical therapy and finding the right balance between rest and activity can also help. There's no cure for RA, but treatment may help relieve symptoms and control the disease. Treatment usually continues throughout your life. But it will vary depending on:

  • The stage. RA may be active or in remission (not having symptoms).
  • How severe RA is.
  • Your treatment history.
  • The benefits and risks of treatment options.
  • What you prefer for treatment options. This includes cost, side effects, and daily schedules.

The goal of treatment is to help you maintain your lifestyle, reduce joint pain, slow joint damage, and prevent disability. Treatment should start with learning about the disease. Learn what might happen with joint damage and disability. Find out the risks and benefits of possible treatments. You and your team of doctors can make a long-term treatment plan.

If you try medicine, exercise, and lifestyle changes for at least a few years but pain and disability get much worse, surgery may be an option.

Medicines

Early and ongoing treatment of RA with medicines called disease-modifying antirheumatic drugs (DMARDs) can reduce how severe the disease is. And it can slow or sometimes prevent joints being destroyed. Other medicines may be combined with DMARDs to relieve symptoms. These medicines include:

  • Medicines that reduce pain and swelling. Examples are ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
  • Medicines that relieve pain. Examples are acetaminophen (Tylenol), codeine, and hydrocodone.
  • Corticosteroids. These may be used for early treatment, to control flare-ups, or to help manage the disease.

Treatment options

Types of treatment that may help you control some of the symptoms of RA include:

  • Self care. This can include rest, protecting your joints, and healthy eating.
  • Physical therapy (PT). This helps improve joint function. PT includes exercise, hot and cold therapy, and massage.
  • Occupational therapy. This helps you learn how to maintain movement in the joints while doing the activities of daily life.
  • Assistive devices such as household aids or mobility aids. For more information and a catalog, contact the Arthritis Foundation at www.arthritis.org.
  • Behavioral modification techniques to reduce pain and stress. They include biofeedback and relaxation therapy, such as breathing exercises and muscle relaxation.
  • Counseling. It can help you cope with long-term pain and disability. Counseling can also help if you feel depressed. It's common for people with RA to feel depressed. Also be sure to seek the help and support you need from friends and family members.
  • Complementary medicine. It's used by many people with RA to relieve symptoms and improve their quality of life. But there isn't strong scientific evidence that it helps. Therapies include acupuncture, herbs and dietary supplements, and massage.

Surgery

Surgical treatment for RA is used to relieve severe pain and improve function of severely deformed joints that don't respond to medicine and physical therapy. There are several types of surgery that are used. The type of surgery you have depends on which joints are affected. Sometimes surgery to replace a joint (such as a hip or knee) is an option. Other types of surgery can remove debris or inflamed tissue from a joint or can relieve pressure on nerves.

Surgery options include:

  • Arthroplasty. This replaces part or all of a joint, such as the hip or knee. Arthroplasty can be done for many different joints in the body. Its success varies depending on which joint is replaced.
  • Arthroscopy. This uses a small lighted instrument to remove debris or inflamed tissue from a joint.
  • Carpal tunnel release. This surgery relieves pressure on the median nerve in the wrist.
  • Cervical spinal fusion. This fusion treats severe neck pain and nerve problems.
  • Finger and hand surgeries. These correct joint problems in the hand.
  • Foot surgery. An example is phalangeal head resection.
  • Synovectomy. This removes inflamed joint tissue.

What Causes It

What causes rheumatoid arthritis (RA)?

The cause of RA isn't fully understood. But it's an autoimmune disease. This means that the body's natural defense system attacks the joints. Genes play a role, but experts don't know exactly what that role is.

What It Is

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is a condition in which the body's own immune system attacks the joints. This causes swollen, stiff, and painful (inflamed) joints, especially in the hands and feet. Over time, RA can damage and deform joints.

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