What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic disease that causes inflammation of the joints. The inflammation can be so severe that the function and appearance of the hands and other parts of the body can be affected. In the hand, RA may cause deformities in the joints of the fingers. This makes moving the hands difficult. Lumps, known as rheumatoid nodules, may form over small joints in the hands and the wrist. Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult RA, which is chronic and lasts a lifetime, children often outgrow JRA. However, the disease can affect bone development in the growing child.

What causes rheumatoid arthritis?

The exact cause of RA is not known. RA is an autoimmune disorder. This means the body's immune system attacks its own healthy cells and tissues. This causes inflammation in and around the joints. It then may lead to a damage of the skeletal system. RA can also cause damage to other organs, such as the heart and lungs. Researchers think certain factors, including heredity, may contribute to the onset of the disease.

RA most often occurs in people from ages of 30 to 50. It happens more in women than in men.

What are the symptoms of rheumatoid arthritis?

The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease often causes inflammation in the same areas on both sides of the body. Symptoms of RA may begin suddenly or slowly over time. Symptoms can occur a bit differently in each person, and may include:

• Pain
• Stiffness, especially in the morning
• Swelling over the joints
• Decreased movement
• Pain that is worse with movement of the joints
• Bumps over the small joints
• Trouble performing activities of daily living (ADLs), such as tying shoes, opening jars, or buttoning shirts
• Decreased ability to grasp or pinch
• Fatigue
• Occasional fever

The symptoms of RA can be like other health conditions. Make sure to see your health care provider for a diagnosis.

How is rheumatoid arthritis diagnosed?

Diagnosing RA may be difficult in the early stages. This is because symptoms may be very mild, and signs of the disease may not be seen on X-rays or in blood tests. Diagnosis starts with a medical history and a physical exam. Tests may also be done, such as:

• X-ray. This is a test that uses a small amount of radiation to create images of internal tissues, bones, and organs onto film.
• Joint aspiration. For this test, a small amount of fluid is taken from a swollen joint. It is done to look for signs of infection or gout.
• Nodule biopsy. Tiny pieces of tissue are taken to look at under a microscope. This helps to check for cancer or other abnormal cells.   
• Blood tests. These tests are done to detect certain antibodies, called rheumatoid factor, and other indicators for RA.

How is rheumatoid arthritis treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. A treatment plan is tailored to you with your health care provider.

There is no cure for RA. The goal of treatment is often to limit pain and inflammation, and help ensure function. You may have one or more types of treatments. Treatment may include:

• Medications. Some medications may be used for pain relief. Some are used to treat inflammation. Others can help to slow the disease from getting worse. Medications are often managed by a rheumatologist. This is a doctor who is a specialist in arthritis and rheumatic diseases. You may need regular blood tests to check how the medications affect your blood cells, liver, and kidneys.
• Splints. Splints may be used to help protect the joints and strengthen the weak joints.
• Physical therapy. Physical therapy may be used to help increase the strength and movement of the affected areas.

In some cases, surgery may be an option if other treatments do not work. Surgery does not cure RA. It helps correct the deformities caused by the disease. After surgery, RA can continue to cause problems in the hand, and may even require more surgery. Repair or reconstruction of the hand and wrist can be done in a variety of ways, including:

• Surgical cleaning. This surgery removes inflamed and diseased tissues in the hands to help increase function.
• Joint replacement. This type of surgery, also called arthroplasty, may be used in cases of severe arthritis of the hand. This surgery may be done on older adults with a lower activity level. Joint replacement may lessen pain and help increase function of the hands and fingers. During the surgery, a joint that has been destroyed by the disease is replaced with an artificial joint. The new joint may be made out of metal, plastic, silicone rubber. Or, if may be made from your own tissue, such as a tendon from another part of your body.
• Joint fusion. For this surgery, a joint is removed, and the two ends of bones are fused together. This makes one large bone without a joint. This is usually done on patients with advanced RA. After the fusion of the bone, there is no movement in the fused joint.

Complications of rheumatoid arthritis

Because RA damages joints over time, it causes some disability. It can cause pain and movement problems that cause a person to be less able to carry out normal daily activities and tasks. This can also lead to problems such as depression and anxiety.

Living with rheumatoid arthritis

Although there is no cure for RA, it is important to help keep joints functioning by reducing pain and inflammation. Work on a treatment plan with your health care provider that includes medication and physical therapy. Work on lifestyle changes that can improve your quality of life. Lifestyle changes include:

• Activity and rest. To reduce stress on your joints, alternate between activity and rest. This can help protect your joints and lessen your symptoms.
• Use of assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and to improve balance.
• Use of adaptive equipment. Reachers and grabbers allow people to extend their reach and reduce straining. Dressing aids help people get dressed more easily.
• Managing use of medications. Long-term use of some anti-inflammatory medications can lead to stomach bleeding. Work with your health care provider to develop a plan to reduce this risk.
• Seek support. Find a support group can help you deal with the effects of RA.

When should I call my health care provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about rheumatoid arthritis

• RA is a chronic disease that causes inflammation of the joints.
• RA may cause deformities in the joints of the fingers, making movement difficult.
• The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows.
• Symptoms may include joint pain, stiffness, and swelling, decreased and painful movement, bumps over small joints, fatigue, or fever.
• Treatment includes medications, splints, physical therapy, and surgery.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.