Rheumatoid Arthritis

Also Known As

This article was last reviewed on

September 12, 2017.

This article waslast modified on June 7, 2018.

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes stiffness, pain, loss of mobility, inflammation, and erosion (deterioration) in the joints. It usually affects multiple joints symmetrically, the hand and wrists most commonly, but also elbows, neck, shoulders, hips, knees, and feet. Other symptoms include fatigue, fever, the development of nodules under the skin, especially at the elbows, and a sense of not feeling well (malaise). People with RA may develop anemia, systemic complications, and may have other co-existing autoimmune disorders and symptoms, such as the dry eyes and mouth associated with Sjögren syndrome.

Rheumatoid arthritis can affect anyone at any age, but it usually develops between the ages of 40 and 60. Over 70% of those affected are women. According to the National Institutes of Health, more than 1.3 million people in the United States have RA. Left untreated, RA can shorten a person's lifespan and can, within a few years, leave many of those affected too disabled to work. The course of RA and its prognosis are variable. It may develop and progress slowly or rapidly. It may go into remission in some people and, in a few, it may go away. Pregnant women with RA frequently have decreased symptoms during their pregnancy and worsened symptoms after giving birth.

RA is different from the most commonly seen form of arthritis: osteoarthritis. Osteoarthritis, also called degenerative joint disease, is associated with joint injury and with the aging process ("wear and tear"). RA is an inflammatory process that affects the lining of the joints (synovium). It usually occurs in a symmetrical way—if one knee is affected, the other knee also is affected. The disease may be partly inherited through genes, but other factors are probably involved, including some kind of a trigger for the gene, perhaps bacteria or viruses. The disease is not contagious, however. Some scientists also think that changes in certain hormones may promote RA in people with certain genes who have been exposed to the triggering agent.

About Rheumatoid Arthritis

Tests
In addition to clinical evaluation involving a discussion of symptoms and a physical exam, laboratory and non-laboratory testing is often done to  help diagnose rheumatoid arthritis (RA), to distinguish it from other forms of arthritis and conditions with similar symptoms, and to evaluate its severity. Testing can also be used to monitor the condition, its potential complications, response to treatment, and to monitor for potential side effects associated with some treatments.

Laboratory tests

Rheumatoid factor (RF) – used to help diagnose RA; it is present in significant concentrations in most people (about 80%) with RA but can also be present in people with other diseases and in a small percentage of healthy people; when positive in someone with symptoms of RA, this test can be useful to confirm the diagnosis.

Cyclic citrullinated peptide (CCP) antibody – may be used to help diagnose RA, especially early in the disease – potentially before symptoms even appear – and in people who are RF-negative; found in 60-70% of people with RA; when used with the RF test, CCP results can help confirm a diagnosis of RA.

Antinuclear antibody (ANA) – this test is used to screen for certain autoimmune disorders, sometimes including RA, but is most often used as one of the tests to diagnose systemic lupus erythematosus (SLE).

Erythrocyte sedimentation rate (ESR) – this test shows the presence of inflammation in the body and the activity of the disease. It is used to help diagnose RA and to evaluate and monitor the condition. ESR will be increased in RA but not in osteoarthritis.

C-reactive protein (CRP) – this test also indicates inflammation and tests for the activity of the disease. It may be used to help diagnose RA and to evaluate and monitor the condition. An increased level of CRP occurs in RA but not in osteoarthritis.

Complete blood count (CBC) – this is a group of tests used to help evaluate the person's red and white blood cells and hemoglobin to help monitor for anemia and/or a decrease in white blood cells.

Comprehensive metabolic panel (CMP) – this is a group of tests that may be used to help evaluate and monitor kidney and liver function.

Non-Laboratory tests

X-ray – used to help diagnose RA and monitor joint damage but will not usually show significant changes early in the disease; can be used to rule out other causes of joint pain.

Ultrasound and MRI – may be used to help detect changes in the joints earlier in the disease.
Treatment

There is no cure for rheumatoid arthritis (RA). The goals of treatment are to slow down the disease, decrease pain and inflammation, maintain joint function, and minimize joint damage and complications. Treatment will vary from person to person and may be adjusted over time.

In addition to getting appropriate rest and exercise and avoiding stress on the affected joints, people with RA may take some medications. These can include analgesics (pain relievers), non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation, corticosteroids to reduce inflammation, disease-modifying antirheumatic drugs (DMARDs) to help slow the course of the disease, and biologic response modifiers to help reduce inflammation and damage to the joints. Immunosuppressants may also be prescribed.

Treatment often involves taking more than one drug and should be started as soon as possible to minimize permanent joint damage. Those affected should work with their rheumatologist and their primary care physician to coordinate their care over time and to take advantage of new treatments as they become available.

If medications are unsuccessful, surgery to repair joints that have been damaged may be indicated.

View Sources

Sourcess Used in Current Review

National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2016. Rheumatoid Arthritis. Available online at https://www.niams.nih.gov/health_info/rheumatic_disease/. Accessed 6/10/2017.

National Rheumatoid Arthritis Society. 2013. What is the Cause of Rheumatoid Arthritis? Non-Genetic Factors. Available online at http://www.nras.org.uk/what-is-the-cause-of-rheumatoid-arthritis-non-genetic-factors. Accessed 6/20/2017.

Rheumatoid Arthritis Support Network. 2016. Rheumatoid Arthritis Diagnosis. Available online at https://www.rheumatoidarthritis.org/ra/diagnosis/. Accessed 6/20/2017.

U.S. National Library of Medicine. 2017. Rheumatoid Arthritis. Available online at https://medlineplus.gov/rheumatoidarthritis.php. Accessed 6/10/2017.

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