Rheumatoid Arthritis > Fact Sheets > Yale Medicine

Overview

If you’re one of 1.5 million people in the United States with rheumatoid arthritis (RA), you’re familiar with the pain and stiffness in your joints that comes with the disease. 

Rheumatoid arthritis is an autoimmune disease in which the body’s immune system begins attacking the lining of its joints, causing pain, inflammation, and, eventually, damage to cartilage and bone. Rheumatoid arthritis can also harm the body’s internal organs, such as the heart, lungs, and nervous system.

The good news is that an early and accurate diagnosis, as well as a personalized treatment plan, can help patients manage symptoms and get back to living a normal life. 

What are the symptoms of rheumatoid arthritis?

The onset of rheumatoid arthritis is often gradual, and not every person experiences the same symptoms. Symptoms can also come and go. You may feel fine for days or months and then experience a flare in pain and swelling in the joints.

The first symptoms people often notice are stiffness and pain or tenderness in their joints. The joints in wrists, hands, fingers, and feet are more commonly affected early in the progression of rheumatoid arthritis.

This stiffness is usually worse in the morning but typically gets better throughout the day. Also, it’s usually present on both sides of the body.

“People tend to have joint pain symmetrically, in multiple joints—in both hands, both wrists, and both knees, for example,” says Cristina Maria Brunet, MD, a Yale Medicine rheumatologist. “But that isn’t always the case. There are exceptions.”

Along with stiffness and pain, people with rheumatoid arthritis sometimes notice warmth, swelling, or redness in their joints. If the disease worsens, it can eventually cause deformities and a loss of function in joints, although these problems are less common now with better and earlier treatment options.

Because of the inflammation in their bodies, people with rheumatoid arthritis often also experience related symptoms, such as fatigue, loss of appetite, and fever.

How is rheumatoid arthritis different from other types of arthritis?

People often confuse rheumatoid arthritis with other types of arthritis or other inflammatory diseases. 

Types of inflammatory arthritis include:

• Psoriatic arthritis: An inflammatory arthritis that usually develops in a person with psoriasis.
• Ankylosing spondylitis: A type of inflammatory arthritis that primarily affects the spine and sacroiliac joints located in the back of the pelvis.
• Juvenile idiopathic arthritis: The most common type of arthritis in children.
• Systemic lupus erythematosus: A chronic autoimmune disease that can cause joint pain, skin rash, and damage to internal organs.

The most common type of arthritis, osteoarthritis, does not usually cause the degree of inflammation found in rheumatoid arthritis and is a different disease with different treatments.

What are the risk factors for rheumatoid arthritis?

Genetics can predispose some people to rheumatoid arthritis. But researchers also say that an environmental trigger—such as an infection or some other type of physical trauma—may be necessary for someone to actually develop rheumatoid arthritis.

However, the science behind this argument is not fully understood, and doctors don’t know what exactly causes rheumatoid arthritis or who is most at risk.

Besides genetics, these factors may make a person more likely to develop rheumatoid arthritis:

Sex: Seventy percent of people with rheumatoid arthritis are women.
Age: Rheumatoid arthritis symptoms can start at any age, but they most commonly begin in people between ages 40 to 60.
Tobacco use: For people who are genetically predisposed to the condition, cigarette smoking raises their risk of developing rheumatoid arthritis or having more severe disease.
Obesity: Being overweight or obese also seems to raise a person’s risk of developing rheumatoid arthritis.

How is rheumatoid arthritis diagnosed?

If a patient has unexplained joint pain and swelling, a doctor may recommend they see a rheumatologist. Rheumatologists specialize in inflammatory conditions and are experienced in diagnosing and treating diseases such as rheumatoid arthritis.

A rheumatologist will perform a general examination and check the patient’s joints for warmth, swelling, tenderness, and range of motion. X-rays may also be done. “They help us assess joint damage and make decisions about how aggressive we need to be with medical therapy,” says Dr. Brunet.

Blood tests can show whether a patient has elevated levels of inflammation in the body. They can also confirm the presence of two antibodies, called rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP). These are often found in the blood of people with rheumatoid arthritis.

By considering the patient’s physical symptoms and the results of tests, a rheumatologist may rule out other conditions and make a diagnosis of rheumatoid arthritis.

What are the treatment options for rheumatoid arthritis?

Medications to treat rheumatoid arthritis can be very effective when the disease is caught early and managed properly.

“We can hope to put people in remission so they can get back to doing whatever they enjoy without limitations,” says Dr. Brunet.

These medications include:

• Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow rheumatoid arthritis progression by suppressing the body’s immune system. 
• Biologics: This subset of DMARDs target specific proteins in the body, so they tend to have less of an effect on the immune system as a whole. They also work by suppressing the immune system.
• Corticosteroids: These drugs, such as prednisone, reduce inflammation and may be given on a short-term basis to relieve joint pain and swelling. They usually aren’t recommended for long-term use because they can cause side effects, including high blood glucose levels and bone thinning.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medicines can be given by prescription or over-the-counter to reduce pain and inflammation. Examples include ibuprofen and naproxen sodium.

Most medicines for rheumatoid arthritis have side effects and risks associated with them, such as a compromised immune system. This can make a person more likely to get sick from infections or other illnesses. Before starting any medication, patients should talk to their doctors about these risks and how to stay safe while taking these drugs.

Part of a patient’s treatment for rheumatoid arthritis may also include physical or occupational therapy to learn exercises that can help keep joints flexible and muscles strong.

Sometimes, if medicine does not work to control rheumatoid arthritis symptoms or if the disease is diagnosed too late, surgery may be recommended to repair or replace damaged joints.

What makes Yale Medicine’s approach to treating rheumatoid arthritis unique?

The physicians at Yale Medicine are world-class experts at identifying and treating rheumatoid arthritis and other inflammatory diseases that are often misdiagnosed. “Inflammatory conditions may all present in similar ways, and it’s really important that the correct diagnosis is made so the right type of treatment can be used,” says Dr. Brunet. 

Our rheumatologists also have extensive experience with rheumatoid arthritis medications. Because these drugs suppress the immune system, they must be prescribed by specialists and carefully explained to patients, she adds.

“We try to individualize the approach to each patient,” Dr. Brunet says. “There’s not one way of evaluating and treating RA, so we discuss every step with patients to make sure they are comfortable with our plan.”

5 Top Facts You Should Know About Rheumatoid Arthritis

Rheumatoid arthritis is surrounded by interesting facts: The disease affects women three times more often than men. Children often outgrow juvenile rheumatoid arthritis, yet the disease is chronic and progressive in adults. And most people don’t know that cigarette smoking is the strongest environmental risk factor for rheumatoid arthritis.

Of all those facts, however, none are in the top five list put together by the team at Prolete Physical Therapy & Sports Medicine in Milford, Connecticut. Here are the most important facts you should know about rheumatoid arthritis.

1. Rheumatoid arthritis is an autoimmune condition

Your immune system normally identifies and attacks bacteria, viruses, and other organisms that make you sick. When you have an autoimmune condition, the immune system mistakenly identifies part of your own body as an invader and mounts an attack against that tissue.

Rheumatoid arthritis develops when your immune system harms the synovium, a tissue that lines the inner surface of your joints. As a result, the lining becomes inflamed and you develop swelling, pain, and stiffness.

2. Rheumatoid arthritis has a unique set of symptoms

The joint pain and stiffness caused by rheumatoid arthritis are classic symptoms similar to those found in osteoarthritis. But rheumatoid arthritis has unique symptoms that set it apart from osteoarthritis, such as:

• Symptoms affect four or more small joints, often starting with your fingers
• Symptoms are symmetrical, affecting the same joints on both sides of your body
• Morning stiffness that lasts an hour or longer

By comparison, osteoarthritis causes morning stiffness that typically lasts 30 minutes or less.

3. Medication is essential for preventing joint deformities

Joint inflammation appears at the start of rheumatoid arthritis and doesn’t improve without medication. Ongoing inflammation changes the bone, leading to excessive bone erosion and joint deformities — a hallmark trait of rheumatoid arthritis.

Today, we have new medications called disease-modifying antirheumatic drugs and biologic response modifiers that are engineered to protect your joints. These medications stop the inflammatory cascade and prevent deformities.

4. Rheumatoid arthritis causes body-wide symptoms

The inflammation that begins in your joints can spread throughout your body, causing a wide range of symptoms depending on the part of the body affected. Body-wide problems affect about 40% of all patients with rheumatoid arthritis.

Some of the most common problems include:

• Eye disorders, such as scleritis and uveitis
• Cardiovascular disease, such as accelerated atherosclerosis
• Blood disorders, such as thrombocytosis and anemia
• Interstitial lung disease, such as pleural effusion and nodules
• Osteoporosis and osteopenia

Rheumatoid arthritis is also associated with problems affecting your kidneys, salivary glands, nerves, and bone marrow.

5. Exercise should be part of your treatment plan

You may not feel like exercising when your joints are painful, swollen, and stiff, but physical activity is one of the best ways to:

• Improve joint function
• Increase range of motion
• Reduce your pain
• Boost your energy
• Get better quality sleep
• Enhance your immune function
• Uplift your emotional well-being

While exercise is vital, it’s also important to know how long you can safely exercise and what type of exercise you can perform without triggering a flare-up. With our extensive experience in physical therapy and rehabilitation, we can develop an exercise plan that fits your lifestyle and works for your stage of rheumatoid arthritis.

To learn more about treatment for rheumatoid arthritis, call Prolete Physical Therapy & Sports Medicine or schedule an appointment online today.

Interesting facts | “RMZH” No. 7 dated 04/10/2014

New genetic links in the development of arthritis have been found
In the largest study to establish the genetic causes of rheumatoid arthritis, involving experts from leading research centers in 12 countries, 42 new genome regions have been found that are associated with the risk of developing this disease.

Experts analyzed the data that were obtained as a result of the complete decoding of the genome of more than 100 thousand participants in the study. Approximately 30 thousand of them were diagnosed with rheumatoid arthritis, and the rest were included in the control group. As a result, about 10 million cases of single nucleotide polymorphism were discovered.
This made it possible to identify 42 previously unknown regions of the genome in which the risk of rheumatoid arthritis is increased, and to isolate 98 genes whose mutations were associated with the development of this disease. Experts have been able to establish a link between these same genes and the risk of developing certain cancers and cardiovascular diseases, effective treatments for which have already been developed. The results suggest that the same methods can be applied in the case of rheumatoid arthritis.

Old joints will be turned into new tissues

Tissue removed during hip replacement surgery is a potential source of stem cells that could be used in regenerative medicine.
Researchers at the Australian University of South Wales studied periosteal stem cells in patients with arthrosis or rheumatoid arthritis who underwent joint replacement surgery. When comparing these cells with bone marrow stem cells, similarities were found between them. Both types of cells can turn into other types of cells.
As can be seen from the study, periosteal tissues can become a source of stem cells for people with joint diseases: bone tissue can be grown from the periosteum and transplanted into a patient.

Fibromyalgia relieved with vitamin D

It turned out that taking vitamin D supplements can not only reduce the pain of fibromyalgia, but also become a cost-effective alternative to other existing methods.
Experts from Austria conducted a study in which 30 patients with fibromyalgia took part. It is noted that the level of calcifediol in their blood was less than 32 ng / ml. All volunteers were divided into 2 groups: the 1st received an oral supplement with cholecalciferol (vitamin D3), and the 2nd received a placebo. The aim of the scientists was to bring in 20 weeks. the level of calcifediol in the blood serum of participants from the 1st group to 32–48 ng/ml. Scientists tracked the performance at the 5th and 13th week. admission, and also after 25 weeks. after the start of the course and after
24 weeks after its complete completion.
Compared to the placebo group, the supplemented group experienced a significant improvement in performance and a reduction in morning fatigue from the start of the course. But vitamin D supplementation did not have a noticeable effect on anxiety and depression. However, the main result of optimizing the level of calcifediol in the blood serum was a significant reduction in pain in the group taking the vitamin supplement, and this effect persisted after 24 weeks. after completing the course.

Lumbar disc replacement

Neurosurgeons of the Sakhalin Regional Hospital performed the first operation on prosthetic intervertebral discs in the lumbar region. The surgical intervention was carried out using modern technologies for intervertebral disc replacement – the latest generation American prosthesis M6-L was used, the press service of the regional Ministry of Health reports.
The operation was performed on a 34-year-old man who has received therapeutic treatment for the last 10 years. According to A. Antonov, head of the neurosurgery department of the hospital, prosthetics using a modern implant will restore the anatomy and physiology of the intervertebral disc.
The implanted functional element of the spine in terms of mobility approaches the mobility of a healthy organ.
“Such a prosthesis supports the natural biomechanics of the spine, providing a reliable and long-term solution to the problem, which is important for patients of working age,” the doctor noted. Over the past 4 years, Sakhalin neurosurgeons have performed cervical vertebrae prosthetics using the M6-L prosthesis.
After A. Antonov was trained in Germany and mastered the features of prosthetics in the lumbar region, the Sakhalin clinic decided to start such operations. However, while the high cost of consumables does not allow them to be performed regularly.

Information taken from open sources

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causes of development, diagnosis and treatment

1. Causes of disease
2. Symptoms of rheumatoid arthritis
3. Stages of rheumatoid arthritis
4. Varieties
5. Rheumatoid arthritis in children
6. Diagnostics
7. Treatment of rheumatoid arthritis
8. Diet
9. Clinical Guidelines

Image by DimaBerlin on Shutterstock

Rheumatoid arthritis (RA) belongs to the category of immunoinflammatory diseases. They cause changes in connective tissue cells, lead to inflammatory processes in the joints and other organs. Rheumatoid arthritis affects the joints of the hands and feet. In addition to the feet, knees, legs, the disease can cause changes in the hip and shoulder joints, and the spine.

Up to 1% of the entire population of the Earth have this disease. Rheumatoid arthritis is 2.5 times more common in women than in men. The disease develops at the age of 40-50 years, but this can happen earlier or later.

Causes of disease

Until now, experts have not established the exact cause that triggers the process of the onset of the disease. In the course of research, scientists came to the conclusion that the disease is hereditary in nature. Infectious diseases can provoke inflammation of the joints and lead to the diagnosis of “rheumatoid arthritis”: herpes, rubella, retroviral infections, cytomegaly. Some people develop the disease after severe stress, moving to an area with a different climate, or hypothermia.

When exposed to factors that have not been fully identified, autoimmune reactions occur that cause inflammatory processes in the periarticular and cartilaginous tissues.

The danger of RA is that it occurs in a chronic form and causes loss of joint function due to deformity and stiffness. With constant inflammation, periarticular tissues and cartilage are destroyed. People with rheumatoid arthritis of the joints lose the ability to move after 10 to 20 years of the disease. This becomes the basis for disability, significant limitation or loss of ability to work.

Symptoms of rheumatoid arthritis

The main signs of rheumatoid arthritis:

• pain when touched and stiffness of the joints;

• increased fatigue;

• subfebrile temperature;

• swelling of the joint, swelling of the affected area;

• increased pain during physical activity, which leads to limited mobility.

With the help of hardware diagnostics, it is possible to detect an accumulation of exudate inside the joint. The doctor also notes fibrotic changes in the synovial membrane, deformation of the affected area.

A characteristic feature of RA are rheumatoid nodules with a diameter of 5 mm to 2 cm, which most often form under the skin on the forearms and the back of the head. These neoplasms can appear not only under the skin, but also on the internal organs. In severe cases, nodules are found in the heart valves, lungs.

A large number of such formations is a sign of exacerbation of rheumatoid arthritis, and when the nodules disappear, remission can be assumed.

Symptoms largely depend on the type of disease and the localization of the pathological process. For example, with rheumatoid arthritis of the hand, carpal tunnel cider develops, pain in the forearm appears, and the mobility and sensitivity of the fingers decrease.

In acute RA, the patient has a fever, severe pain in muscles and joints, and rapid changes in tissues. If the disease develops slowly, then functional disorders occur gradually, that is, the patient may not be aware of the problem for many months.

Stages of rheumatoid arthritis

The disease develops in three phases/stages:

• In the first stage, the patient feels pain in the joints during physical activity. Another sign is joint stiffness in the morning.

• At the second stage, stiffness becomes pronounced, exudative changes are observed. Pain persists even at rest, hyperthermia of the skin appears on the affected areas.

• In the third stage, severe pain and constant stiffness occur, which limit the mobility of the joint. This stage is also characterized by pronounced exudative changes, swelling of soft tissues.

If a patient with rheumatoid arthritis neglects the recommendations of the attending physician, then the disease develops rapidly and begins to spread throughout the body. The pathological process covers the muscles. Muscle tone drops, strength indicators deteriorate. This leads to the development of muscle atrophy. After that, the skin is affected, it becomes thinner, becomes dry. The blood circulation in the area of ​​the nail plates is disturbed, they change shape and become brittle. In some areas, foci of necrosis are formed, which poses a threat to life.

With improperly selected treatment or non-compliance with clinical recommendations, rheumatoid arthritis affects the digestive and respiratory organs, the central nervous system, kidneys, heart, and blood vessels. Against the background of the disease, complications such as:

• colitis and enteritis;

• neuropathy, VVD;

• inflammation of the lungs, alveoli and bronchioles, pleurisy;

• inflammatory diseases of the kidneys;

• myocarditis, inflammation of the coronary vessels, endocarditis;

• the appearance of ulcers and rashes on the skin;

• vascular thrombosis;

• uterine bleeding.

Among the deadly complications of RA are myocardial infarction, chronic renal failure, the appearance of fistulas in the tissues of the bronchi and pleura.

Varieties

The term “rheumatoid arthritis” refers to a number of pathologies in which the joints suffer:

Depending on the presence or absence of rheumatoid factor in the joint fluid, seropositive and seronegative rheumatoid arthritis are distinguished.

Rheumatoid arthritis in children

The disease affects adults and children. If the disease appeared before the age of 16, it is called juvenile or adolescent RA. Up to 0.6% of children suffer from this pathology, and girls get sick almost twice as often as boys. Juvenile RA is one of the causes of disability at a young age.

Diagnostics

If rheumatoid arthritis is suspected, the patient is referred to a rheumatologist. He orders a series of tests to help assess joint health. To diagnose rheumatoid arthritis, x-rays of the joints are performed, and an MRI may also be prescribed. Tests for rheumatoid arthritis include a general clinical and biochemical blood test to detect indicators of rheumatoid factor, taking a sample of intra-articular fluid.

Treatment of rheumatoid arthritis

Treatment for rheumatoid arthritis includes medications, physical therapy, and other treatments. To relieve inflammation and pain, NSAIDs (non-steroidal anti-inflammatory drugs) and corticosteroids are prescribed: dexamethasone and others. They fight inflammation, have immunosuppressive, anti-allergic effects. They are prescribed for acute and chronic diseases of the connective tissue.

Patients also undergo membrane plasmapheresis and other extracorporeal hemocorrection procedures, due to which the level of antibodies in the blood serum decreases. To maintain the mobility of the joints, physiotherapy exercises, swimming are shown.

Surgical treatment of RA is effective, which consists in replacing the destroyed joint with a prosthesis. This operation is called arthroplasty.

In recent years, new methods of treating RA have emerged. One of them is the introduction into the body of a special drug for rheumatoid arthritis, which blocks the anti-inflammatory cytokine protein. Experts also have high hopes for stem cell therapy.

Diet

When diagnosed with RA, patients need a certain nutrition system. A properly selected diet promotes the synthesis of anti-inflammatory enzymes and enhances the effect of drug therapy.

A rheumatoid arthritis diet should provide the body with enough essential nutrients and help maintain a healthy weight. It is important to get the required amount of protein, as with chronic inflammation of the joints, its loss occurs. Another important component of nutrition in RA is derivatives of arachidonic acid, which is part of phospholipids. The source of arachidonic acid is beef, poultry, fatty fish, eggs and butter.

When compiling a diet for a patient with RA, the amount of salt, animal fats and carbohydrates is reduced.