Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and can affect other parts of the body. Various treatment options can help manage it.

RA usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body.

Common symptoms include stiff joints, especially when getting up after sleeping or after sitting down for a while. Some people experience fatigue and a general feeling of being unwell.

The Rheumatoid Arthritis Support Network estimates that RA affects up to 1% of the world’s population and over 1.3 million Americans.

The incidence of RA has increased globally over the past decades and will continue to increase in the coming years.

RA is an autoimmune disease, which means that a person’s immune system mistakes the body’s healthy tissues for foreign invaders. It is also a systemic disease that can affect the whole body.

As the immune system responds, inflammation occurs in the target tissue or organ. This can include the joints, lungs, eyes, and heart in RA.

Signs and symptoms of RA usually occur in the wrists, hands, or feet and include:

The following images show how RA can present physically:

According to the Centers for Disease Control and Prevention (CDC), people most often experience the onset of RA in their 60s. Symptoms may start slowly and often worsen gradually with time.

People with RA usually experience periods when their symptoms get worse, known as flares. RA symptoms may flare up due to stress, overactivity, or stopping medications.

Sometimes, a person with RA can go into remission if their symptoms go away or are mild. Most people continue to experience flares and remissions throughout their lives.

RA usually affects the same joints on both sides of the body. Pain and stiffness tend to worsen after periods of inactivity.

Severe RA can lead to other complications throughout the body and cause joint damage that may lead to disability. Treatment can help manage the severity of symptoms and may reduce the likelihood of experiencing complications.

Nobody knows exactly what causes the immune system to malfunction, which leads to RA.

It’s thought to be a combination of genetics and environmental factors.

In RA, the immune system attacks the synovium, the membrane lining of joints. When this happens, the synovial cells proliferate, which leads to synovial thickening. Pain and inflammation result.

Eventually, if left untreated, the inflammation can invade and destroy cartilage — the connective tissue that cushions the ends of the bones. The tendons and ligaments that hold the joint together can also weaken and stretch. The joint can eventually lose its shape and configuration, and the damage can be severe.

Learn more about genetic and hereditary RA here.

RA is an autoimmune disease that causes inflammation in the joints, leading to pain, stiffness, and swelling. Osteoarthritis leads to many of the same symptoms as RA but is due to the typical wear and tear of the joints.

While RA usually affects the same joints on both sides of the body, osteoarthritis may only affect one side.

Although other symptoms can help a person figure out if they are experiencing RA or osteoarthritis, only a doctor can diagnose these conditions.

The CDC notes that people with a higher risk of developing RA may include those who:

  • are 60 years or older
  • are female
  • have specific genetic traits
  • have never given birth
  • have obesity
  • smoke tobacco or whose parents smoked when they were children

Learn more about the risk factors for RA here.

It may be difficult for a doctor to diagnose RA in its early stages, as it can resemble other conditions such as lupus (SLE) or psoriatic arthritis (PsA).

The CDC recommends getting a diagnosis within six months of the onset of symptoms so that treatment can begin as soon as possible.

A doctor will look at the person’s clinical signs of inflammation and ask how long the person has experienced them and how severe their symptoms are. They will also perform a physical examination to check for swelling, functional limitations, or other unusual presentations.

They also may recommend some tests, including:

Blood tests

Several blood tests can help diagnose RA and rule out other conditions. They include:

Imaging scans and X-rays

An X-ray or MRI of a joint can help a doctor identify what type of arthritis is present and monitor the progress of a person’s RA over time.

Diagnostic criteria

Guidelines recommend the following criteria for diagnosing RA:

  • number and location of affected joints
  • blood tests indicate the presence of RA
  • symptom duration
  • inflammation indicators, or acute phase reactants

If a person has a diagnosis of RA, a doctor may refer them to a specialist known as a rheumatologist, who will advise on treatment options.

Treatment will aim to:

  • prevent flares and reduce their severity if they occur
  • reduce inflammation in the joints
  • relieve pain
  • minimize any loss of function caused by pain, joint damage, or deformity
  • slow down or prevent damage to joints and organs

Options include medications, physical therapy, occupational therapy, counseling, and surgery.

Medications to manage symptoms

Some drugs can help relieve symptoms and slow the disease’s progression.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are available from pharmacies over the counter (OTC). Examples include Motrin, Advil, and Aleve.

Long-term use and high doses can lead to side effects, including:

Corticosteroids reduce pain and inflammation and may help slow joint damage, but they cannot cure RA.

If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of the symptoms.

This can help with acute symptoms or short-term flare-ups. However, a doctor will limit steroid injections to no more than three times per year because of their impact on the soft tissue structures around the joints. More frequent injections can potentially damage these structures or cause them to tear off from where they attach to bone.

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs affect how the immune system works. They can slow the progression of RA and prevent permanent damage to joints and other tissues by interfering with an overactive immune system. A person usually takes DMARDs for life.

These types of medications are most effective if a person uses them in the early stages of RA, but it can take several weeks to a couple of months to fully experience their benefits. Some people may have to try different types of DMARDs before finding the most suitable one.

Side effects can include:

Biologic treatments

Biologic treatments, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, also change how the immune system works. When the human body faces an infection or other threat, it produces TNF-alpha, an inflammatory substance. TNF-alpha inhibitors suppress this substance and help prevent inflammation.

TNF-alpha inhibitors can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an improvement two weeks after starting treatment.

Examples include:

Possible side effects include:

JAK inhibitors

Janus kinase (JAK) inhibitors are a newer subtype of DMARD medications. These include:

While traditional DMARDs stop the immune system from producing immune cells that cause RA to develop, JAK inhibitors target specific signaling molecules. This helps prevent the cellular process that causes RA to progress.

For the 20–30% of people living with rheumatoid arthritis who do not respond to traditional DMARDs or biologics, JAK inhibitors have proven to be an effective option.

Occupational or physical therapy

An occupational therapist can help a person learn new and effective ways of carrying out daily tasks. This can minimize stress on painful joints. For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.

A physical therapist can advise people about using assistive devices, such as a cane, and help individuals develop a suitable exercise plan.

Surgery

In some cases, a doctor may recommend surgery to:

The following procedures are possible:

Finding time to practice self-care can help a person cope with the day-to-day challenges that RA brings. Several strategies that may help a person manage their condition include.

What are the stages of rheumatoid arthritis?

RA generally develops in four stages:

Stage 1: An X-ray will not show any bone or joint destruction.

Stage 2: An X-ray will show the impact on the bone.

Stage 3: An X-ray will show a particular kind of erosion of the cartilage and bone that a doctor can recognize as resulting from RA and deformities in the affected joints.

Stage 4: The person will experience ankylosis, which is when a joint becomes stiff and fuses with the bone.

Learn more about the four stages of RA here.

Is rheumatoid arthritis hereditary?

Research has determined that there are genes that make developing RA more likely.

One theory is that bacteria or viruses trigger RA in people who have these genes. One of the genes that may be responsible is HLA-DR4, and it is common in people of European ancestry.

However, this may not fully explain why some people get RA and others do not. There are likely environmental triggers also.

Can a person prevent rheumatoid arthritis?

Rheumatoid arthritis (RA) cannot be completely prevented, as its exact cause is not fully understood and involves a combination of genetic, environmental, and possibly hormonal factors.

However, a person can reduce their risk and potentially delay the onset of RA by taking several steps that include but are not limited to:

  • stopping smoking
  • reducing exposure to inhaled silica, dust, and occupational risks
  • maintaining a healthy weight
  • increasing leisure time physical activity

Learn more about smoking and RA here.

What is the life expectancy of a person with rheumatoid arthritis?

According to a 2015 study, people with RA might have a 54% higher risk of mortality compared with people who do not have the condition.

RA patients often face additional chronic medical conditions and complications, severely impacting their health outcomes.

Notably, there is a strong association between RA and atherosclerotic cardiovascular disease, leading to accelerated coronary artery disease.

However, it is difficult to predict a person’s life expectancy as the course of the disease differs significantly among individuals.

With the right treatment, many people can live past the age of 80 or even 90 years while experiencing relatively mild symptoms and only minor limitations in day-to-day life.

Rheumatoid arthritis is a painful chronic autoimmune condition that can cause joint damage and make it difficult for a person to carry out their daily tasks. It can affect joints but can also lead to inflammation throughout the body.

Anyone who experiences pain and swelling in two or more joints not caused by trauma should see a doctor, as early treatment can reduce the risk of long-term problems.