Information - Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic condition that causes pain, swelling, and stiffness in the joints. Affecting about 1% of the population, it is one of the most common types of inflammatory arthritis. RA is a systemic rheumatic disease, which means that it can affect the entire body.
Rheumatoid arthritis is a long-term autoimmune disease. Although the reason why is not well understood, a variety of factors may be involved including genetics, hormones and environmental factors.
RA occurs when the body’s immune system attacks its own healthy tissues and cells. As a result, patients may experience fatigue in addition to joint pain, swelling and stiffness.
It's essential that rheumatoid arthritis is treated as early as possible to prevent further joint damage. Not only can early treatment prevent crippling pain, it can also reduce the risk of other medical conditions associated with chronic inflammation, such as heart disease.
Fortunately, with proper treatment, many patients with rheumatoid arthritis are able to live healthy and active lives.
Rheumatoid Arthritis Symptoms
Pain, Swelling & Stiffness
Rheumatoid arthritis causes pain and swelling in the joints, resulting in stiffness. At its onset, RA usually affects only a few joints. It may start in the knees, hands, wrists or feet and slowly begin to affect other joints. In some patients, rheumatoid arthritis seems to move from joint to joint. Many people say their rheumatoid arthritis symptoms are worse in the morning.
Rarely, RA symptoms appear suddenly. A person may go to bed feeling fine, but find it difficult to get out of bed in the morning.
Flare-ups are common in autoimmune disorders. If you have rheumatoid arthritis, there might be times when your symptoms flare and are more severe.
People with RA commonly feel tired, because their body’s immune system is attacking its own tissues and joints.
Over time, rheumatoid arthritis can affect other tissues and organs throughout the body, including the:
- Blood vessels
Depending on the part of the body that's affected, patients may experience a range of symptoms.
Rheumatoid arthritis is usually diagnosed by a rheumatologist, a doctor who specializes in autoimmune diseases and arthritis.
To diagnose RA, a physician will take a complete medical history and perform a physical examination. In most cases, they will also order blood tests and x-rays to help confirm the diagnosis.
Common Tests to Diagnose Rheumatoid Arthritis
There is no single test that can diagnose rheumatoid arthritis. Also, some patients may have normal results from certain blood tests, even though they have RA. That's why rheumatologists consider various factors when diagnosing a patient with rheumatoid arthritis.
Rheumatoid arthritis is an inflammatory disease, so blood tests often show abnormal results. Common tests that detect inflammation include a Complete Blood Count (CBC), C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR).
A rheumatologist will also look for a type of autoantibody called Rheumatoid Factor (RF). This antibody, which targets the body’s own tissues, is elevated in 80% of people with RA. However, a positive test can be from another cause, and a patient who tests negative can still have rheumatoid arthritis.
Another autoantibody that can be detected in the blood is the Anti-Cyclic Citrullinated Peptide Antibody. The anti-CCP test looks for anti-citrullinated protein antibodies (ACPAs), which target the body’s own tissues. This autoantibody is present in 60-70% of people who develop RA.
However, like with the Rheumatoid Factor test, a patient can test positive due to another cause, and someone who tests negative can still have rheumatoid arthritis.
X-rays can show damage to the joints from rheumatoid arthritis. They can also help physicians track the progression of RA over time.
The earlier RA is treated the better the outcome—even a few months can make a difference. Research shows that if rheumatoid arthritis is diagnosed and treated early, patients are more likely to go into remission.
It's important for patients to attend their rheumatologist appointments and maintain a healthy lifestyle. Smoking is especially known to worsen RA symptoms and make it much more difficult to treat.
Because rheumatoid arthritis is linked to heart disease, patients also need to keep their blood pressure and cholesterol at healthy levels. If you have diabetes, it's important to keep your blood sugar under control.
Treatments for Rheumatoid Arthritis
Medications that Treat Rheumatoid Arthritis
There are two broad groups of medications for RA: one that helps control the symptoms and one that prevents long-term joint damage. Make sure to tell your doctor about your alcohol intake and any other medications, supplements or alternative therapies you take to avoid negative interactions.
Disease Modifying Anti-Rheumatic Drugs (DMARDs)
DMARDs are generally used to treat anyone with rheumatoid arthritis, and are often prescribed in combination with other medications.
Methotrexate is the most common Disease Modifying Anti-Rheumatic Drug. It may be given once a week as tablets or as an injection under the skin. In most patients, the injection works better than the tablets and may have fewer side effects.
Other types of DMARDs include:
- Hydroxychloroquine (Plaquenil)
- Gold (Myochrisine)
- Leflunomide (Arava)
Rheumatologists often prescribe a triple therapy combination of Methotrexate, Hydroxychloroquine and Sulfasalazine.
Non-Steroidal Anti-Inflammatory Drugs
Also known as NSAIDs, these medications reduce joint inflammation and reduce pain, but do not prevent the progression of rheumatoid arthritis. With 20 different anti-inflammatory medications available, you can always try a different NSAID if one doesn't work for you.
Analgesic medications are used to control pain, but they don't prevent further joint damage. Analgesics range from over-the-counter acetaminophen to stronger pain narcotics like morphine.
Some patients find relief from inflammation, pain and stiffness by using prednisone. However, because it can have side effects when used long-term, doctors generally prescribe it in high doses for short periods of time.
Cortisone injections are another option for some people with rheumatoid arthritis.
If your joint pain and stiffness isn't well-controlled by anti-inflammatory medications and Disease Modifying Anti-Rheumatic Drugs, your rheumatologist may prescribe advanced therapeutics.
These medications are made up of biologic medications and small molecules. They're given by an injection under the skin or by an intravenous infusion.
There are a number of effective Anti-Tumor Necrosis Factor biologics available, including:
- Humira (adalimumab)
- Remicade/Inflectra/Remsima (infliximab)
- Cimzia (certolizumab)
- Enbrel/Brenzys/Erelzi (etanercept)
- Simponi (golimumab)
There are other biologics that target aspects of the inflammatory response, including Kevzara (sarilumab) and Actemra (tocilizumab), which block an important signalling protien involved in inflammation called Interleukin-6.
Or, you may benefit from alternative therapies such as:
- Rituxan (rituximab), which targets a marker on the surface of immune cells
- Orencia (abatacept), a medication that interrupts communication between immune cells
Surgery for Rheumatoid Arthritis
If you have severe rheumatoid arthritis, your joints may become so badly damaged that they no longer function. In this case, surgery may help reduce pain, restore function and improve mobility.
Surgery for RA typically involves replacing a damaged joint with an artificial joint.
People with rheumatoid arthritis should discuss treatment options with their rheumatologist to determine the best options for managing pain and preventing the progression of the disease.
Print this Action Plan and check off items that you want to discuss with your healthcare provider
Symptoms of rheumatoid arthritis include joint pain, swelling and stiffness. At first, rheumatoid arthritis usually only attacks a few joints, but over time it affects more.
Unlike some other types of arthritis, the chronic swelling from rheumatoid arthritis can cause permanent damage to the joints.
Rheumatoid arthritis treatments include disease modifying anti-rheumatic drugs (DMARDs) and biologics (medications produced from living organisms or components of living organisms). Other medication options include nonsteroidal anti-inflammatory medications (NSAIDs) and analgesics (painkillers).
If you aren’t responding to first-line rheumatoid arthritis therapies, then your rheumatologist may be looking at offering you a second-line therapy. Second-line therapies are a major advance to the treatment of rheumatoid arthritis, and may be pills, injections under the skin or intravenous infusions.
In addition to medications for rheumatoid arthritis, canes, crutches and walkers can help people stay mobile. You may also need to make lifestyle changes to manage your condition and reduce your risk of heart disease.