What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is an incurable chronic inflammatory disease that causes pain, stiffness, swelling, and loss of function in the joints throughout the body, but most typically affects the small joints of the hands and feet. The immune system is supposed to protect the body, but with rheumatoid arthritis, it turns against the body, attacking tissues and even organs including the eyes and lungs. Rheumatoid arthritis can strike at any age although it usually begins between the ages of 40 and 60 and is more common in women than men. Early diagnosis is important because if left untreated, it can cause joint damage and even permanent joint destruction.
Rheumatoid arthritis increases the risk of developing other health problems including osteoporosis – bone loss that leads to weak and brittle bones that are highly susceptible to fracture; carpal tunnel syndrome, a condition caused by a pinched nerve in the wrist that leads to numbness, tingling and weakness in the hands and wrists; heart problems such as clogged arteries, heart attack and heart failure; and inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
Causes of Rheumatoid Arthritis
Rheumatoid arthritis symptoms are caused by inflammation. That means your body’s immune system is releasing chemicals into your blood and joints that cause pain, swelling, stiffness, and fatigue. Why? Because when you have RA, the normal signals that tell your immune system to spring into action — to protect your body from harm by viruses, bacteria, or injuries — are crossed. That’s called autoimmunity. In an autoimmune disease like RA, your immune system triggers inflammation and attacks your healthy joints and tissues by mistake. That’s why you have pain, swelling, and other symptoms.
Sometimes you feel like your immune system is constantly attacking your body; at other times symptoms will come and go. As a reminder, RA is different than OA (osteoarthritis), which is caused by mechanical wear and tear on joints, not an autoimmune process. However, both types of arthritis may occur at the same time.
Even over just a few months or years, RA inflammation can do a lot of damage to the lining around your joints, called the synovium. This inflamed lining can cause damage to the tissues around your joint, like your cartilage or ligaments that hold the joint together. When your cartilage breaks down, your bones can rub against each other and cause more pain. If your ligaments tear, your joints may dislocate and later become deformed. If that happens, joints can look twisted or gnarled, and be harder to move.
Symptoms of Rheumatoid Arthritis
Rheumatoid arthritis symptoms can be different for each person, but here are the most common ones:
- Joint pain, swelling, or redness, often in the same joint on both sides of your body
- Morning stiffness lasting over an hour with “regelling,” or stiffness, after sitting for a while
- Fatigue, or feeling very tired most of the time
- Feeling sick, almost like you have the flu
- Achy muscles
- Loss of your appetite, so you may lose weight without wanting to
- Rheumatoid nodules, or swollen bumps under your skin around your joints
- Painful reactions in your eyes or in the lining around your heart or lungs (less common than other symptoms)
- Cognitive dysfunction (“brain fog”) — a decrease in your ability to think, remember, or concentrate to the point that it interferes with your daily functioning. The exact cause of this is unknown. It could be related to the inflammation, chronic pain, or even lack of sleep.
RA can cause you to develop holes or “erosions” in the bones around your joints. These erosions are caused by inflammatory substances that can dissolve tiny parts of the bone. This is also called “erosive disease.” Early treatment may help you prevent bony erosions, so it’s important to get a diagnosis as soon as you can.
To prevent painful bone problems like holes or “erosions” from happening or to slow them down, you have to get your inflammation under control. That’s what your treatment plan — including your RA drugs and other steps like exercise — is designed to do. You want to get inflammation and your disease activity under control.
Rheumatoid Arthritis Comorbidities
A comorbidity is a condition you have at the same time as your primary condition. Many people with RA have one or more of four common comorbidities: chronic respiratory conditions, diabetes, heart disease, and stroke. This might be a result of the inflammation in RA or because RA can lead to decreased mobility, which can increase the risk of these other health problems.
Rheumatoid Arthritis Contraindications
Contraindications are situations when you should avoid taking a certain medication for health reasons. For example, you should not take DMARD therapy (an RA medication that slows down the progression of your disease. DMARD stands for disease-modifying antirheumatic drug) if you are pregnant; have alcoholism; have alcoholic liver disease or other severe chronic liver disease; have immunodeficiency syndromes such as HIV/AIDS (some patients with HIV can take DMARDS and biologics under careful monitoring), in which your immune system is not working properly (overt or laboratory evidence); or have pre-existing blood dyscrasias (for example, bone marrow hypoplasia, leukopenia, thrombocytopenia, or significant anemia).
If you have active hepatitis A, B, or C, you will need to be treated for that by a liver specialist before you take any drugs for your RA that suppress your immune system or affect your liver. Your liver specialist and rheumatologist can both decide, if once your hepatitis is either stabilized or being treated, that you can start to take certain medications for your RA. But you’ll need to be monitored closely. You may need to come in for blood tests often.
If you have had a previously treated skin cancer, make sure that you are followed closely by your dermatologist as certain RA medication can increase the risk of certain types of skin cancer.
If you have had a previously treated lymphoproliferative disorder, or cancer of any type, you will need to speak with your rheumatologist, as certain RA medications may be better to use in that case. Your rheumatologist may want to speak with your oncologist to figure out the best medication for you.
For more information about existing medications for rheumatoid arthritis and how they work, read our section on RA medication.
How often should I see my doctor for lab work?
Monitoring with blood tests (commonly referred to as “lab work”) is recommended to make sure the treatment that you and your doctor select is both safe and effective. Your doctor may recommend frequent lab work while taking medications for RA, especially when you first start a new medication. Learn more about what your labs mean.