Rheumatoid arthritis

  • Definition
    • Rheumatoid arthritis (RA) is a long-term disease. It leads to inflammation of the joints and surrounding tissues. It can also affect other organs.

      Rheumatoid Arthritis in Adults: Symptoms You Should Know

      1. The first symptom of rheumatoid arthritis (RA) is most often:

        1. A. Pain in the joints of the hands and feet
        2. B. Pain in the hips and shoulders
        3. C. Headache
        4. D. All of the above

        The correct answer is pain in the joints of the hands and feet. RA often starts in the small joints of the fingers and toes. As the arthritis becomes worse, the pain spreads to joints in the ankles, elbows, hips, knees, and shoulders. If you think you may be having symptoms of RA, see your doctor.

      2. RA usually develops slowly.

        1. A. True
        2. B. False

        The correct answer is true. The symptoms of RA most often begin slowly over weeks to a few months. You may notice fatigue and minor joint pain and stiffness, most likely in the morning. Over time, the symptoms can change or become more severe. Ask your doctor about ways to help control symptoms.

      3. The symptoms of RA can come and go.

        1. A. True
        2. B. False

        The correct answer is true. Some people have periods when they have no symptoms at all. These are called remissions. Then they might have periods when the symptoms are worse, called flares. Work with your doctor to figure out what might trigger your flares.

      4. Along with joint pain and swelling, RA can also cause:

        1. A. Dry eyes and mouth
        2. B. Burning or itchy eyes
        3. C. Slight fever
        4. D. Trouble sleeping
        5. E. B and C
        6. F. All of the above

        The correct answer is all of the above. Other symptoms of RA can include fatigue, nodules under the skin, loss of appetite, and numbness or tingling in the hands or feet. If you have joint pain and any of these symptoms, talk to your doctor.

      5. Everyone with RA usually has all of the symptoms.

        1. A. True
        2. B. False

        The correct answer is false. The symptoms of RA can vary widely from person to person. Your symptoms may also change day-to-day as your RA progresses. Ask your doctor about any new or unusual symptoms.

      6. People with RA usually feel best in the morning.

        1. A. True
        2. B. False

        The correct answer is false. The joint stiffness caused by RA is usually worst in the morning. This is one clue to diagnosing RA, since people with other types of arthritis usually feel less pain in the morning.

      7. RA symptoms occur in the same joint on both sides of the body.

        1. A. True
        2. B. False

        The correct answer is true. RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the joints most often affected.

      8. RA is caused by wear and tear on your joints:

        1. A. True
        2. B. False

        The correct answer is false. RA is an autoimmune disease. This means the body's immune system mistakenly attacks healthy tissue in your joints. Over time, RA can cause your joints to become deformed. This is one reason why it's important to talk to your doctor if you think you have RA. Early treatment can help prevent joint damage.

      9. RA can also affect the lungs, heart, or eyes.

        1. A. True
        2. B. False

        The correct answer is true. The inflammation that causes RA can also affect other organs, such as the lungs, heart, or eyes. Over time, RA can cause damage to these organs. Getting early treatment for RA can help reduce your risk for these problems.

      10. It's easy to diagnose RA.

        1. A. True
        2. B. False

        The correct answer is false. Early on, symptoms of RA are often similar to other bone and joint problems. Diagnosing RA can be tricky. And there's no one test for RA. To diagnose RA, your doctor will review your symptoms and may run tests to look for markers of RA.

      11. Most people with RA begin having symptoms in their 30s.

        1. A. True
        2. B. False

        The correct answer is false. Most people with RA first notice symptoms between the ages of 40 and 60. However, people of all ages can get RA. If you have any symptoms of RA, no matter what your age, see your doctor.

  • Alternative Names
    • RA; Arthritis - rheumatoid

  • Causes
    • The cause of RA is unknown. It is an autoimmune disease. This means the body's immune system mistakenly attacks healthy tissue.

      Rheumatoid arthritis

      RA can occur at any age, but is more common in middle age. Women get RA more often than men.

      Infection, genes, and hormone changes may be linked to the disease. Smoking may also be linked to RA.

      It is much less common than osteoarthritis, which is a condition that occurs in many people due to wear and tear on the joints as they age.

  • Symptoms
    • Most of the time, RA 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. Early symptoms may include 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 in the same joint on both sides of the body. The joints are often swollen.
      • Over time, joints may lose their range of motion and may become deformed.
      Rheumatoid arthritis

      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 (most often a sign of more severe disease)
      • Numbness, tingling, or burning in the hands and feet
      • Sleep difficulties
  • Exams and Tests
  • Treatment
    • RA most often requires long-term treatment. Treatment includes medicines, physical therapy, exercise, education, and possibly surgery. Early, aggressive treatment for RA with newer drug categories can be very helpful to slow joint destruction and prevent deformities.


      Disease modifying antirheumatic drugs (DMARDs): These are often the drugs that are tried first in people with RA. They are prescribed along with rest, strengthening exercise, and anti-inflammatory drugs.

      • Methotrexate is the most commonly used DMARD for rheumatoid arthritis. Leflunomide and hydroxychloroquine may also be used.
      • Sulfasalazine is a drug that is often combined with methotrexate and hydroxychloroquine (triple therapy).
      • It may be weeks or months before you see any benefit from these drugs.
      • These drugs may have serious side effects, so you will need frequent blood tests when taking them.

      Anti-inflammatory medicines: These include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and celecoxib.

      • These drugs work well to reduce pain and swelling. Long-term use can cause stomach problems, including ulcers and bleeding, and possible heart problems.
      • Since they do not prevent joint damage if used alone, DMARDS should be used as well.

      Antimalarial medicines: This group of medicines includes hydroxychloroquine (Plaquenil). They are most often used along with methotrexate. It may be weeks or months before you see any benefit from these drugs.

      Corticosteroids: These medicines work very well to reduce joint swelling and inflammation, but they can have long-term side effects. Therefore, they should be taken only for a short time and in low doses when possible.

      Biologic agents: These drugs are designed to affect parts of the immune system that play a role in the disease process of rheumatoid arthritis.

      They may be given when other medicines for rheumatoid arthritis have not worked. Sometimes biologic drugs are started sooner, along with other rheumatoid arthritis drugs. However, because they are very expensive, insurance approval is generally required.

      Most of them are given either under the skin or into a vein There are different types of biologic agents.

      Biologic agents can be very helpful in treating rheumatoid arthritis. However, people taking these drugs must be watched very closely because of serious risk factors:

      • Infections from bacteria, viruses, and fungi
      • Leukemia or lymphoma
      • Psoriasis
      • Allergic reactions


      Surgery may be needed to correct severely damaged joints. Surgery may include:

      • Removal of the joint lining (synovectomy)
      • Total joint replacement in extreme cases: may include total knee replacement, hip replacement, ankle replacement, shoulder replacement, and others


      Range-of-motion exercises and exercise programs prescribed by a physical therapist can delay the loss of joint function and help keep muscles strong.

      Sometimes, therapists will use special machines to apply deep heat or electrical stimulation to reduce pain and improve joint movement.

      Other therapies that may help ease joint pain include:

      • Joint protection techniques
      • Heat and cold treatments
      • Splints or orthotic devices to support and align joints
      • Frequent rest periods between activities, as well as 8 to 10 hours of sleep per night


      Some people with RA may have intolerance or allergies to certain foods. A balanced nutritious diet is recommended. It may be helpful to eat foods rich in fish oils (omega-3 fatty acids). Smoking cigarettes should be stopped. Excessive alcohol should also be avoided.

  • Support Groups
  • Outlook (Prognosis)
    • How well a person does depends on the severity of symptoms and the response to treatment. It is very important to have regular return visits to the provider, who will adjust treatment to control the arthritis.

      Permanent joint damage may occur without proper treatment. Early treatment with a three-drug DMARD combination known as "triple therapy," or with the biologic drugs, can decrease joint pain and damage. These drugs are given by specialists called rheumatologists.

  • Possible Complications
    • If not well treated, 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

      However, these complications can most often be avoided with proper treatment. The treatments for RA can also cause serious side effects. Talk to your health care provider about the possible side effects of treatment and what to do if they occur.

  • When to Contact a Medical Professional
    • Call your health care provider if you think you have symptoms of rheumatoid arthritis.

  • Prevention
    • There is no known prevention. Smoking cigarettes appears to worsen RA, so it is important to avoid tobacco. Proper early treatment can help prevent further joint damage.

  • References
    • Mason JC. Rheumatic diseases and the cardiovascular system. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 84.

      McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011;365:2205-2219. PMID: 22150039

      O'Dell JR. Rheumatoid arthritis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 264.

      O'Dell JR, Mikuls TR, Taylor TH, et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med. 2013;369:307. PMID: 23755969
      Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016;68(1):1-26. PMID: 26545940

      Sweeney SE, Harris ED, Firestein GS. Clinical features of rheumatoid arthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 70.