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Definition  

Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs mostly in the:

  • Fingers
  • Wrists
  • Elbows
  • Shoulders
  • Jaw
  • Hips
  • Knees
  • Toes
Rheumatoid Arthritis  
rheumatoid arthritis

© 2009 Nucleus Medical Media, Inc.

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Causes  

RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response. Possible causes:

  • Genetic factors—Certain genes that play a role in the immune system are associated with RA development.
  • Defects in the immune system can cause ongoing inflammation.
  • Environmental factors—Certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA.
  • Other factors—Some evidence suggests that hormonal factors may promote RA development in combination with genetic factors and environmental exposure.
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Risk Factors  

These factors increase your chance of developing RA. Tell your doctor if you have any of these risk factors:

  • Family members with RA
  • Sex: female
  • Ethnic background: Pima Indians
  • Heavy or long-term smoking
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Symptoms  

When RA begins, symptoms may include:

  • Joint pain and stiffness that is:
    • Symmetrical
    • Most prominent in the morning
    • Lasts for at least half an hour
  • Red, warm, or swollen joints
  • Joint deformity
  • Mild fever, tiredness
  • Loss of appetite
  • Small lumps or nodules under the skin

As RA progresses, it may cause complications with the:

  • Heart
  • Lungs
  • Eyes
  • Skin
  • Liver
  • Kidneys
  • Blood
  • Nervous system
  • Blood vessels

It is also linked to early cardiovascular disease and death.

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Diagnosis  

There is no single test for RA. The doctor will ask about your symptoms and medical history. She will examine your joints, skin, reflexes, and muscle strength.

Tests:

  • Rheumatoid factor (RF) level in the blood
  • Erythrocyte sedimentation rate (ESR) of the blood—to measure inflammation in the body
  • C-reactive protein (CRP) —an indicator of active inflammation in the blood
  • White blood cell count
  • X-rays of affected joints (especially dual energy x-ray absorptiometry )—a test that uses radiation to take a picture of structures inside the body, especially bones
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Treatment  

There is no cure for RA. The goals of treatment are to:

  • Relieve pain
  • Reduce inflammation
  • Slow down joint damage
  • Improve functional ability
Medications  

FDA Public Health Advisory for TNF-Inhibitors

Children and teens who take TNF-inhibitors may be at an increased risk of Hodgkin’s and non-Hodgkin’s lymphoma and other types of cancer. For more information, please visit: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm175843.htm

Steroids  

Low-dose corticosteroids (eg, prednisone ) are often used first. They may be tapered when other drugs start working. Avoid long-term steroid use. Corticosteroid injections to inflamed joints may also be used.

Rest and Exercise  

Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.

Joint Care  

Splints applied to painful joints may reduce pain and swelling. Devices that help with daily activities can also reduce stress on joints. Devices include:

  • Zipper extenders
  • Long-handled shoehorns
  • Specially designed kitchen tools
Stress Reduction  

Stress reduction can ease the difficulties of living with a chronic, painful disease. Participating in an exercise program or joining a support group are two strategies you can use to reduce stress. Cognitive behavioral therapy , a form of talk therapy, and meditation may also offer benefits in reducing your pain and improving your ability to cope with RA.

Surgery  

Joint replacement and tendon reconstruction help relieve severe joint damage.

Lifestyle Measures  

These may relieve stiffness and weakness and reduce inflammation:

  • Maintain a balance between rest and exercise.
  • Attempt mild strength training.
  • Participate in aerobic exercise (eg, walking, swimming, dancing).
  • Avoid heavy impact exercise.
  • If you smoke, quit .
  • Control weight.
  • Participate in a physical therapy program.
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Prevention  

There are no guidelines for preventing RA.