Understanding Rheumatoid Arthritis

Rheumatoid arthritis (RA) can affect the body in many ways, including complications such as heart disease, chronic inflammation, and fatigue.
It’s an autoimmune condition that produces symptoms across multiple body systems.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disease that leads to inflammation of the joint lining (synovium), causing pain, swelling, and stiffness. It most often involves the small joints of the fingers, hands, wrists, knees, ankles, feet, and toes. A hallmark feature is that RA usually affects the same joints on both sides of the body, which helps distinguish it from other forms of arthritis.

If left uncontrolled, the ongoing inflammation damages cartilage which are the “shock absorber” of joints. Over time, this can lead to joint deformity, and eventually erosion of the underlying bone. In advanced cases, joint fusion may occur.

What are the stages of rheumatoid arthritis?

Rheumatoid arthritis typically progresses through four stages:

• Stage 1 (Early RA): Inflammation develops in the tissues surrounding affected joints. Symptoms may include pain and stiffness, but X-rays don’t show bone damage at this stage.
• Stage 2 (Moderate RA): Inflammation begins to damage cartilage. Patients often notice reduced flexibility and worsening stiffness.
• Stage 3 (Severe RA): Inflammation extends to the bones, leading to visible joint changes, more severe pain, stiffness, and reduced mobility.
• Stage 4 (End-stage RA): Inflammation subsides, but joint destruction continues. Severe pain, swelling, stiffness, and loss of movement occur.

Progression through these stages can take years, and not everyone advances through all of them.

When does rheumatoid arthritis typically develop?

RA most often appears between ages 30 and 60, but it can develop at any age.

• When symptoms begin between 16 and 40, it’s referred to as young-onset rheumatoid arthritis (YORA).
• When RA starts after age 60, it’s called later-onset rheumatoid arthritis (LORA).

Symptoms and Causes

What are the main symptoms?

Common symptoms include:

• Pain, swelling, stiffness, and tenderness in more than one joint.
• Morning stiffness or stiffness after long periods of sitting.
• Symmetrical symptoms (affecting the same joints on both sides).
• Fatigue.
• Weakness.
• Fever.

The course of RA varies from person to person. Some develop symptoms gradually over years, while others progress quickly. RA often follows a pattern of flare-ups (active symptoms) alternating with periods of remission (few or no symptoms).

What are the early warning signs?

Early RA may present as tenderness or pain in small joints, like the fingers or toes, or in larger joints such as the knees or shoulders. These subtle symptoms can feel like a weak alarm, that is easy to miss, but important to recognize early. Prompt diagnosis allows early treatment, which reduces the risk of permanent joint damage.

What causes RA?

The exact trigger remains unclear, but RA likely results from a combination of genetic, hormonal, and environmental factors.

Normally, the immune system protects the body from infections. In RA, the immune system mistakenly attacks joint tissues. Possible triggers include infections, smoking, and physical or emotional stress.

Is RA genetic?

Certain genetic variations increase RA risk, especially variations in the human leukocyte antigen (HLA) genes, which help the immune system distinguish self-proteins from foreign invaders like bacteria or viruses. However, non-genetic factors, such as sex, smoking, and environmental exposures, also play a role.

Who is at risk?

Risk factors include:

• Family history: A close relative with RA raises your risk.
• Sex: Women are about three times more likely than men to develop RA.
• Smoking: Raises the risk and worsens the disease.
• Obesity: Increases the likelihood of developing RA.

What are the complications?

Without proper treatment, RA can cause:

• Irreversible joint damage or deformity.
• Increased risk of viral infections.
• Dry eyes and dry mouth.
• Carpal tunnel syndrome.
• Osteoporosis.
• Heart disease.
• Interstitial lung disease.
• Lymphoma.

Diagnosis and Tests

How is RA diagnosed?

Diagnosis is typically made by a rheumatologist. They combine medical history, a physical exam, lab tests, and imaging studies. Sometimes they observe disease progression over time before confirming the diagnosis.

Blood tests look for inflammation and RA-related antibodies, such as:

• Erythrocyte sedimentation rate (ESR, or “sed rate”).
• C-reactive protein (CRP).
• Rheumatoid factor (RF).
• Cyclic citrullinated peptide (CCP) antibodies.

Imaging tests assess joint damage and may include:

• X-rays.
• Ultrasound.
• MRI.

Management and Treatment

How is RA treated?

The primary treatment goals are to reduce joint pain and swelling, maintain or restore joint function, and prevent long-term joint damage. Effective management also improves quality of life.

Most people need medication, and some may require surgery. Treatment choices depend on age, health status, medical history, and disease severity.

Medications

Early initiation of treatment improves long-term outcomes. Often, a combination of medications is more effective than single-drug therapy.

Common drug categories include:

• Disease-modifying antirheumatic drugs (DMARDs).
• Non-steroidal anti-inflammatory drugs (NSAIDs).
• Corticosteroids.
• Janus kinase (JAK) inhibitors.
• Biologic therapies.

The safest medication is the one that balances maximum benefit with minimal side effects, which differs from person to person. A rheumatologist will design a personalized treatment plan.

Surgery

When severe joint damage limits function or pain cannot be controlled by medications, surgery may be considered. Surgical options include:

• Knee replacement.
• Hip replacement.
• Procedures to correct deformities.

Outlook / Prognosis

There is no current cure for RA, but many effective strategies exist to reduce pain, control inflammation, and slow disease progression. Early diagnosis and treatment are crucial.

Without treatment, RA can cause irreversible cartilage and joint destruction, and may also damage organs like the heart and lungs.

Living With Rheumatoid

• See your rheumatologist regularly to monitor disease activity and medication side effects. They may adjust your dose or switch medications as needed.
• Always continue your medications until your rheumatologist advises otherwise.
• Support your health with balanced nutrition and daily physical activity.
• If you smoke, quitting is strongly recommended.