Rheumatoid arthritis, or RA, is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system — which is designed to protect our health by attacking foreign cells such as viruses and bacteria — instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that’s systemic — meaning it can occur throughout the body. Rheumatoid arthritis is a chronic disease, meaning it can’t be cured. Most people with RA experience intermittent bouts of intense disease activity, called flares. In some people the disease is continuously active and gets worse over time. Others enjoy long periods of remission – no disease activity or symptoms at all. Evidence shows that early diagnosis and aggressive treatment to put the disease into remission is the best means of avoiding joint destruction, organ damage and disability.
The cause of rheumatoid arthritis is unknown. Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research. It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited (hereditary). Certain genes have been identified that increase the risk for rheumatoid arthritis. It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body's own tissues. This leads to inflammation in the joints and sometimes in various organs of the body, such as the lungs or eyes.
RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected.
The disease often begins slowly, usually with only minor joint pain, stiffness, and fatigue.
Joint symptoms may include:
- Morning stiffness, which lasts more than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour.
- Joint pain is often felt on the same joint on both sides of the body.
- Over time, joints may lose their range of motion and may become deformed.
Other symptoms include:
- Chest pain when taking a breath (pleurisy)
- Dry eyes and mouth (Sjogren syndrome)
- Eye burning, itching, and discharge
- Nodules under the skin (usually a sign of more severe disease)
- Numbness, tingling, or burning in the hands and feet
- Sleep difficulties
Unlike diabetes or kidney disease, rheumatoid arthritis (RA) cannot be diagnosed with a simple blood test. Instead, the diagnosis often takes time and is based largely on what the doctor hears from you (the medical history) and observes in you (the physical exam).
During the medical history, your doctor will ask questions about specific joints as well as how you feel in general. Because findings from the medical history play a major role in the diagnosis, it’s important to give your doctor clear and accurate answers to questions, such as the following:
- Do you have pain in many joints? People with rheumatoid arthritis often have pain in several joints at once as opposed to just one.
- Do the same joints on both side of your body hurt at the same time? Symmetric pain is often as sign of rheumatoid arthritis. For example, if one wrist or knee is inflamed or painful, the other wrist or knee will likely be as well.
- When is the pain most severe? People with rheumatoid arthritis often feel worst when they first wake up, and then later in the day when fatigue sets in.
- Have you had periods of feeling weak and uncomfortable all over? Many people with rheumatoid arthritis notice generalized problems, such as muscle aches, fatigue, stiffness, weight loss and flu-like symptoms.
There is no known cure for rheumatoid arthritis. To date, the goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function, stop damage to joints as monitored on X-rays, and prevent work disability. Optimal treatment for the disease involves a combination of medications, rest, joint-strengthening exercises, joint protection, and patient (and family) education. Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation. Treatment is most successful when there is close cooperation between the doctor, patient, and family members.
Rheumatoid arthritis can affect nearly every part of the body. Complications may include:
- Damage to the lung tissue (rheumatoid lung)
- Increased risk of hardening of the arteries
- Spinal injury when the neck bones become damaged
- Inflammation of the blood vessels (rheumatoid vasculitis), which can lead to skin, nerve, heart, and brain problems
- Swelling and inflammation of the outer lining of the heart (pericarditis) and of the heart muscle (myocarditis), which can lead to congestive heart failure
The treatments for RA can also cause serious side effects. Talk to your doctor about the possible side effects of treatment and what to do if they occur.