What is rheumatoid arthritis?

Rheumatoid arthritis (RA): Overview

Arthritis is a common health problem in which the joints are inflamed. There are many types of arthritis. In rheumatoid arthritis, the body's own immune system attacks the joints. This causes pain, stiffness, and swelling in the joints, especially in the hands and feet. It can become hard to open jars, write, and do other daily tasks. Sometimes rheumatoid arthritis can also cause bumps to form under the skin.

Over time, rheumatoid arthritis can damage and deform joints. Early treatment with medicines may reduce your chances of having a lasting disability.

Rheumatoid arthritis (RA)

Rheumatoid arthritis is a type of arthritis in which your body's immune system attacks healthy tissue in your joints. This makes the joints swollen, stiff, and painful. Over time, it may destroy the joint tissues and make it hard for you to walk and use your hands.

Medicine may help control rheumatoid arthritis or keep it from getting worse.

What happens when you have rheumatoid arthritis (RA)?

RA usually progresses slowly, over months or years. RA mostly affects the joints. But it can also cause problems in the eyes, lungs, heart, blood vessels, muscles, and nerves. If the disease progresses it can cause lasting disability. But early treatment may control it and keep it from getting worse.

Rheumatoid Nodules

Picture of rheumatoid nodules

Rheumatoid nodules are small bumps under the skin, located in pressure point areas such as the elbow, back of the hand, or back of the heel. These bumps may be as small as a grain of rice or as large as a golf ball. But they are usually not painful, and they tend to come and go.

Your doctor may remove rheumatoid nodules if your disease is under good control and the nodules are painful or very bothersome.

How is rheumatoid arthritis (RA) treated?

RA is most often treated with medicine. Some medicines help to control the symptoms. Other medicines, especially when used early, can help to prevent the disease from getting worse.

Many of the medicines used to treat rheumatoid arthritis have side effects. Have regular checkups. And talk with your doctor about any problems. This will help your doctor find a treatment that works for you.

Physical therapy and finding the best balance between rest and activity can also help your symptoms.

If your treatment doesn't help, surgery may be an option. The type of surgery you can have depends on which joints are causing problems. Sometimes surgery to replace a joint (such as a hip or knee) is an option. Other types of surgery can remove debris or inflamed tissue from a joint, or relieve pressure on nerves.

X-Ray of Rheumatoid Arthritis in the Hands

X-ray images showing a normal hand and a hand with rheumatoid arthritis

Figure 1 courtesy of Intermountain Medical Imaging, Boise, Idaho. Figure 2 courtesy of Paul Traughber, M.D., Boise, Idaho.

The X-ray on the left shows a normal hand.

The X-ray on the right shows a hand with advanced rheumatoid arthritis. "Bone erosion" means cartilage and bone are worn away. "Bone displacement" means that a bone has moved out of its normal position. This X-ray shows how bone erosion and bone displacement can change the shape of the hand.

How are medicines used to treat rheumatoid arthritis (RA)?

Medicines are the main treatment for RA. The types of medicines used, the amount you take, and the length of time you take them depends on how severe your RA is, how fast it's progressing, and how it affects your daily life.

Medicines are used to:

  • Relieve or reduce pain.
  • Improve daily function.
  • Reduce joint inflammation.
  • Prevent or delay serious joint damage and deformity.
  • Prevent lasting disability.
  • Improve quality of life.

Medicines called disease-modifying antirheumatic drugs (DMARDs) can slow or sometimes prevent joints from being destroyed. An early start to treatment with DMARDs can reduce how severe RA is. These medicines are most often taken over a long period to help control the disease.

Other medicines may be combined with DMARDs to relieve symptoms. They include:

  • Medicines that reduce pain and swelling. These include aspirin, ibuprofen, and naproxen.
  • Corticosteroids. An example is prednisone.
  • Medicines that relieve pain. These include acetaminophen, acetaminophen combined with codeine or hydrocodone, and tramadol.

How can you care for yourself when you have rheumatoid arthritis (RA)?

  • If your doctor recommends it, get more exercise. Walking is a good choice. If your knees or ankles hurt, try riding a stationary bike or swimming.
  • Move each joint gently through its full range of motion once or twice a day.
  • Rest joints when they are sore or overworked. Short rest breaks may help more than staying in bed.
  • Reach and stay at a healthy weight. Regular exercise and a healthy diet will help you do this. Extra weight can strain the joints, especially the knees and hips, and make the pain worse. Losing even a few pounds may help.
  • Get enough calcium and vitamin D to help prevent osteoporosis, which causes thin bones. Talk to your doctor about how much you should take.
  • Protect your joints from injury. Do not overuse them. Try to limit or avoid activities that cause joint pain or swelling. Use special kitchen tools and other self-help devices as well as walkers, splints, or canes if needed.
  • Use heat to ease pain. Take warm showers or baths. Use hot packs or a heating pad set on low. Sleep under a warm electric blanket.
  • Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Take an active role in managing your condition. Set up a treatment plan with your doctor, and learn as much as you can about rheumatoid arthritis. This will help you control pain and stay active.

How is surgery used to treat rheumatoid arthritis (RA)?

Surgical treatment for RA is used to relieve severe pain and improve function of severely deformed joints that don't respond to medicine and physical therapy.

Surgery options include:

  • Arthroplasty. This replaces part or all of a joint, such as the hip or knee. It can be done for many different joints in the body. How well it works depends on which joint is replaced.
  • Arthroscopy. This uses a small lighted tool to remove debris or inflamed tissue from a joint.
  • Carpal tunnel release. It relieves pressure on the median nerve in the wrist.
  • Cervical spinal fusion. It treats severe neck pain and nerve problems.
  • Finger and hand surgeries. They correct joint problems in the hand.
  • Foot surgery. An example is phalangeal head resection.
  • Synovectomy. It removes inflamed joint tissue.

What increases your risk for rheumatoid arthritis?

Things that may increase your risk for rheumatoid arthritis include:

  • Being female. Rheumatoid arthritis affects women 2 to 3 times as often as men.
  • Being middle-aged. Rheumatoid arthritis can begin at any age, but it most often begins in adulthood.
  • Smoking cigarettes.

How can exercise help with rheumatoid arthritis (RA)?

Exercise can reduce pain and improve function in people who have RA. It may also help prevent the buildup of scar tissue. This can lead to weakness and stiffness. Exercise for arthritis takes three forms:

Stretching.

Stretching involves moving joint and muscle groups through and slightly beyond their normal range of motion and holding them in position for at least 15 to 30 seconds.

Strengthening.

Strengthening involves moving muscles against some resistance. Strengthening exercise helps people who have RA stay more active and able to do their daily activities. It even seems to help their outlook.

Conditioning.

Conditioning exercise improves aerobic fitness. It may help reduce pain and help you stay more active. Even moderate activity, such as walking, can improve your health and may prevent disability from RA.

Be sure to follow your doctor's advice about your exercise program.

Rheumatoid Arthritis Zones

Picture of the common sites for rheumatoid arthritis

Rheumatoid arthritis often affects small and large joints on both sides of the body (symmetry), such as both hands, both wrists or elbows, or the balls of both feet.

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is a condition in which the body's own immune system attacks the joints. This causes swollen, stiff, and painful (inflamed) joints, especially in the hands and feet. Over time, RA can damage and deform joints.

What causes rheumatoid arthritis (RA)?

The cause of RA isn't fully understood. But it's an autoimmune disease. This means that the body's natural defense system attacks the joints.

Genes play a role, but experts don't know exactly what that role is. For most people with RA, the disease doesn't run in their families and they don't pass it along to their children. One or more genes may make it more likely that the body's immune system will attack the tissues of the joints. This immune response may also be triggered by bacteria, a virus, or some other foreign substance.

Rheumatoid arthritis: When to call

Call your doctor now or seek immediate medical care if:

  • You have a fever or a rash along with joint pain.
  • You have joint pain that is so severe that you cannot use the joint at all.
  • You have sudden swelling, redness, or pain in one or more joints, and you do not know why.
  • You have back or neck pain along with weakness in your arms or legs.
  • You have a loss of bowel or bladder control.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You have joint pain that lasts for more than 6 weeks.
  • You have side effects from your arthritis medicines, such as stomach pain, nausea, heartburn, or dark and tarlike stools.

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