Rheumatoid arthritis

What is it?

According to the NIAMS: rheumatoid arthritis is a "chronic (long-term) autoimmune disease that mainly affects the joints", in which the immune system attacks body tissues causing pain, swelling, stiffness and loss of joint function. MedlinePlus states that it usually affects the wrist and fingers but may involve any joint tissue and other systems such as the eyes, skin, heart, nerves, blood and lungs. The CDC says it mainly damages the joints of the hands, wrists and knees and may affect the lungs, heart and eyes.

According to the NHS: a long-term condition that causes joint pain, swelling and stiffness, especially in the hands, feet and wrists. This page does not cover specific prevalence figures, and the NIAMS states that women are affected about two to three times as often as men.

Causes

According to the NIAMS: the exact cause is unknown but three factors contribute: genes that affect how the immune system works (without guaranteeing on their own that the disease occurs), environmental factors, such as "cigarette smoke may trigger the disease in people with certain genes", including inhaled substances, bacteria, viruses, gum disease and lung disease, and sex hormones, as women are affected more and the disease may change with pregnancy. The NHS says the immune system mistakenly attacks the cells lining the joints and that the trigger is unclear.

Risk factors

According to the NIAMS and MedlinePlus: advancing age (though it can occur at any age), female sex, family history, long-term smoking, obesity, gum disease, and lung disease. The CDC adds that the risk peaks between ages 50 and 59 and that women are two to three times more affected, and mentions HLA class II genes and childhood exposures such as parental smoking. The NHS mentions being female, family history and smoking.

Symptoms

According to the NIAMS: joint pain at rest and on movement with tenderness, swelling and warmth, joint stiffness lasting more than 30 minutes often after waking, swelling that interferes with daily activities, and tiredness, low energy, sometimes a mild fever and loss of appetite. Symptoms are often symmetrical on both sides of the body, and the severity of the disease varies between people. The CDC mentions pain and stiffness in more than one joint, weight loss and weakness, and periods of flare and remission. The NHS mentions flares, and MedlinePlus mentions rheumatoid nodules (hard lumps under the skin near the joints).

How is it diagnosed?

According to MedlinePlus: there is no single diagnostic test; assessment is based on the medical and family history and clinical examination, and blood tests or imaging (X-ray or ultrasound) to rule out other conditions, and referral to a rheumatologist is common. According to the NIAMS: blood tests include rheumatoid factor (RF), anti-CCP antibodies, a full blood count, erythrocyte sedimentation rate and C-reactive protein, as well as tests of kidney, liver, thyroid and muscle function, and imaging by X-ray, MRI and ultrasound (which help detect the disease early) and other tests according to the case. The CDC mentions clinical examination, X-rays, blood tests and review of the health history.

Treatment

The treatment categories usually used are listed here; this is not a prescription. The doctor chooses the plan according to each person's condition; do not change any medicine or dose without a specialist.

Treatment categories according to the NIAMS: anti-inflammatory medicines, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), biologic response modifiers (biologics), and JAK inhibitors. The CDC describes DMARDs as slowing disease progression and preventing joint deformity and biologics as suppressing specific components of the immune system. The doctor (often a rheumatologist) chooses the category, dose and duration according to your condition and tests; do not change medicine on your own. MedlinePlus also states that surgery may be an option.

According to the NHS: there is no cure, but long-term medicines ease symptoms and slow progression, along with physiotherapy and occupational therapy, and surgery for severe joint problems. MedlinePlus says: "There is no cure for rheumatoid arthritis, but early treatment can prevent symptoms from worsening".

Lifestyle according to the NIAMS: balancing rest and exercise (more rest when the disease is active), protecting the joints with splints and assistive devices, managing stress with relaxation, yoga or tai chi, monitoring symptoms to detect a flare, a healthy weight and balanced nutrition, and psychological and social support. MedlinePlus mentions physical activity, avoiding joint injuries and quitting smoking.

Follow-up

According to the NIAMS, care of the disease involves a team including a rheumatologist, physical and occupational therapists, orthopaedic surgeons, the primary care provider, a podiatrist, a heart and lung specialist, a pharmacist, a dietitian and a mental health professional. This page does not cover specific follow-up intervals or monitoring tests for disease medicines.

Complications

According to the NIAMS: rheumatoid nodules, anaemia, neck pain, dry eyes and mouth, inflammation of blood vessels, lungs or heart, and lung scarring and inflammation. The NIAMS (diagnosis page) mentions accompanying problems including osteoporosis, cardiovascular and respiratory complications and a higher risk of infection. The NHS mentions carpal tunnel syndrome and inflammation of other organs (lungs, heart and eyes) and a higher risk of heart attack and stroke. MedlinePlus mentions heart and lung disease, eye complications and sleep disorders.

According to the NIAMS, if left untreated the disease may worsen, affect more joints and increase disability.

Living with it

The aim of treatment according to the NIAMS: to control the disease until "remission or near remission" with no signs or symptoms. The NHS says many people have months or years between flares and carry on working and being active with good treatment. This page does not cover specific remission rates.

Common questions