Rheumatoid Arthritis

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Arthritis is a general term that describes inflammation in joints. Inflammation is characterized by redness, warmth, swelling, and pain in the joint.

Rheumatoid arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both sides of the body (such as both hands, wrists, and/or knees). This symmetric multiple joint involvement helps distinguish rheumatoid arthritis from other types of arthritis.

In addition to affecting the joints, rheumatoid arthritis may occasionally affect organs outside of the joints including the skin, eyes, lungs, heart, blood, nerves, or kidneys.

What are the symptoms of rheumatoid arthritis?

  • Joint pain
  • Joint swelling
  • Stiffness – especially in the morning or after sitting for long periods
  • Fatigue – best defined as tiredness and excessive sleepiness

How does rheumatoid arthritis affect people?

Rheumatoid arthritis affects each individual differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may progress rapidly. Other people may have rheumatoid arthritis for a limited period of time and then enter a remission (a time with no symptoms).

Who is affected by rheumatoid arthritis?

Rheumatoid arthritis affects more than 1% of the United States population. It is three to five times more common in women than men. It usually occurs between the ages of 20 to 50; however, young children and the elderly can also develop rheumatoid arthritis.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is unknown. However, it is believed to be caused by a combination of genetic factors, abnormal immunity, environmental factors, and hormonal factors.

Normally, the immune system protects the body from disease. In rheumatoid arthritis, something triggers the immune system to attack the joints and sometimes other organs. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the joints. Some people have a genetic or inherited factor that makes them more likely to develop rheumatoid arthritis.

What are the results of joint inflammation?

Once the immune system is triggered, cells migrate from the blood into the joints and produce substances that cause inflammation.

The increased number of cells and inflammatory substances within the joint cause:

  • Irritation/disruption
  • Wearing down of cartilage (cushions at the end of bones)
  • Swelling of the joint lining (synovium)
  • Production of fluid in the diseased joint lining (synovial fluid)

As the cartilage wears down, the space between the bones narrows. If the condition worsens in the late stage, the bones could rub against each other just like what is seen in osteoarthritis (degeneration) in the elderly.

As the joint lining grows, it may invade or erode into the bone, resulting in irreversible damage to the bone. All of these factors cause the joint to become very painful, tender, swollen and warm to touch.

How is rheumatoid arthritis diagnosed?

The diagnosis of rheumatoid arthritis is based on a combination of factors, including:

  • The specific location and symmetry of painful joints
  • The presence of joint stiffness in the morning
  • Presence of bumps/nodules under the skin (rheumatoid nodules)
  • Results of x-ray tests that suggest rheumatoid arthritis
  • Positive results of a blood test called the rheumatoid factor*

*Approximately 70% of people with rheumatoid arthritis have the rheumatoid factor antibody in their blood. The rheumatoid factor may be present in 5% of people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. A test called CCP antibody can sometimes help to determine whether the rheumatoid factor antibody is due to rheumatoid arthritis or some other disease. That is why the diagnosis of rheumatoid arthritis is based on a combination of several factors and NOT just the presence of the rheumatoid factor in the blood.

How is rheumatoid arthritis treated?

There are many different ways to treat rheumatoid arthritis. Treatments include medications, rest and exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.

The type of treatment prescribed will depend on several factors including the person’s age, overall health, medical history and severity of the arthritis.

Medications

There are many medications available to decrease joint pain, swelling and inflammation and hopefully prevent or minimize the progression of the disease. These medications include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs – such as aspirin, ibuprofen or naproxen)
  • Corticosteroids (oral and injectable forms)
  • COX-2 inhibitors (celecoxib)
  • Disease-modifying anti-rheumatic drugs (DMARDs)* such as hydroxychloroquine, methotrexate, sulfasalazine, cyclophosphamide, and leflunomide
  • Biologic agents (such as infliximab, etanercept, adalimumab, anakinra, rituxamab, abatacept, certolizumab and golimumab)

*Some of these medications are traditionally used to treat other conditions such as cancer, inflammatory bowel disease, malaria, and organ transplant rejection. When these drugs are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less than when these drugs are used to treat cancer or other conditions.

When you are prescribed any medication, it is important to meet with your physician regularly so he or she can detect the development of any side effects.

Rest and exercise

A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups (worsening of joint inflammation), it is best to rest the joints that are inflamed. This may be accomplished by the temporary use of a cane or joint splints.

When joint inflammation is decreased, guided exercise programs are necessary to maintain flexibility of the joints and to strengthen the muscles that surround the joints. Range-of-motion exercises should be done regularly to maintain joint mobility. Physical therapy and occupational therapy have also been found to be helpful.

Surgery

When bone damage from the arthritis has become severe or pain is not controlled with medications, surgery is an option to restore function to a damaged joint.

Is there hope for people with rheumatoid arthritis?

Yes. Although there is not yet a cure for rheumatoid arthritis, there are many effective methods available for decreasing the pain and inflammation, and slowing down the disease process. Early diagnosis and effective treatment is of great importance.

Extensive research is in progress to determine the cause of rheumatoid arthritis and the best method of treatment.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/9/2011…#4924

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