Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long-term (chronic) disease that causes inflammation of the joints. The inflammation can be so severe that it affects how the joints and other parts of the body look and function. In the hand, RA may cause deformities in the joints of the fingers. This makes moving your hands difficult. Lumps, known as rheumatoid nodules, may form anywhere in the body.

Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis (JRA), is a form of arthritis in children ages 16 or younger. It causes inflammation and joint stiffness that last for more than 6 weeks. Unlike adult RA, which lasts a lifetime, children often outgrow JIA . But the disease can affect bone development in a growing child. Some children with JIA will continue to have arthritis into adulthood.

Doctors don't know the exact cause of RA. RA is an autoimmune disorder. This means the body's immune system attacks its own healthy cells and tissues. This causes inflammation in and around the joints. This may damage the skeletal system. RA can also damage other organs, such as the heart and lungs. Researchers think certain factors, including heredity, may be a factor.

RA most often occurs in people from ages 30 to 50, but it can occur at any age. It happens more in women than in men.

The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease often causes inflammation in the same areas on both sides of the body. Symptoms may start suddenly or slowly over time. Each person’s symptoms may vary. They may include:

• Joint pain
• Stiffness, especially in the morning
• Swelling over the joints
• Decreased movement
• Pain that is worse with joint movement
• Bumps over the small joints
• Trouble doing activities of daily living, such as tying shoes, opening jars, or buttoning shirts
• Trouble grasping or pinching things
• Tiredness and lack of energy (fatigue)
• Occasional fever

These symptoms can seem like other health conditions. Always see your healthcare provider for a diagnosis.

Diagnosing RA may be difficult in the early stages. This is because symptoms may be very mild, and signs of the disease may not be seen on X-rays or in blood tests. Your healthcare provider will take your health history and give you a physical exam. You may need tests such as:

• X-ray. This test uses a small amount of radiation to create images of internal tissues, bones, and organs onto film.
• Joint aspiration. For this test, a small fluid sample is taken from a swollen joint. It is done to look for signs of infection or gout.
• Nodule biopsy. Tiny tissue samples are taken to look at under a microscope. This helps to check for cancer or other abnormal cells.   
• Blood tests. These tests are done to find certain antibodies called rheumatoid factor, cyclic citrullinated antibody, and other signs of RA.
• Ultrasound or MRI. These imaging tests can look for bone damage and inflammation. 

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

There is no cure for RA. The goal of treatment is often to limit pain and inflammation, and help you retain function. You may have one or more types of treatments. Treatment may include:

• Medicines. Some medicines may be used for pain relief. Some are used to treat inflammation. Others can help slow the disease from getting worse. Early treatment slows progression of the disease. Medicines should be managed by a rheumatologist. This is a doctor who specializes in arthritis and rheumatic diseases. You may need regular blood tests to check how the medicines affect your blood cells, liver, and kidneys.
• Splints. Splints may be used to help protect the joints and strengthen weak joints.
• Physical therapy. Physical therapy may be used to help increase the strength and movement of the affected areas.

In some cases, you may need surgery if other treatments don’t work. Surgery does not cure RA. It helps correct the deformities caused by the disease. After surgery, RA can still cause problems. You may even need more surgery. Joint repair or reconstruction can be done in many ways, including:

• Surgical cleaning. This surgery removes inflamed and diseased tissues in the hands to help increase function.
• Joint replacement (arthroplasty). This type of surgery may be used in cases of severe arthritis of the hand. It may be done on older adults who are not so active. Joint replacement may reduce pain and help increase joint function. During the surgery, a joint that has been destroyed by the disease is replaced with an artificial joint. The new joint may be made out of metal, plastic, or silicone rubber. Or it may be made from your own tissue, such as a tendon from another part of your body.
• Joint fusion. For this surgery, a joint is removed, and the two ends of bones are fused together. This makes one large bone without a joint. This is usually done on people with advanced RA. After the bone fusion, the fused joint can’t move.

Because RA damages joints over time, it causes some disability. It can cause pain and movement problems. You may be less able to do your normal daily activities and tasks. This can also lead to problems such as depression and anxiety.

RA can also affect many non-joint parts of the body, such as the lungs, heart, skin, nerves, muscles, blood vessels, and kidneys. These complications can lead to severe illness and even death.

There is no cure for RA. But it is important to help keep your joints working well by reducing pain and inflammation. Work on a treatment plan with your healthcare provider that includes medicine and physical therapy. Work on lifestyle changes that can improve your quality of life. Lifestyle changes include:

• Activity and rest. To reduce stress on your joints, switch between activity and rest. This can help protect your joints and ease your symptoms.
• Using assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and to improve balance.
• Using adaptive equipment. Reachers and grabbers let you extend your reach and reduce straining. Dressing aids help you get dressed more easily.
• Managing use of medicines. Medicines for this condition have some risks. Work with your healthcare provider to create a plan to reduce this risk.
• Seeking support. Find a support group that can help you deal with the effects of RA.

Tell your healthcare provider if your symptoms get worse or you have new symptoms.

• RA is a long-term (chronic disease) that causes joint inflammation.
• RA can also affect many non-joint areas such as the lungs, heart, skin, nerves, muscles, blood vessels, and kidneys.
• RA may cause deformities in the joints of the finger, making movement difficult.
• The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows.
• Symptoms may include joint pain, stiffness, and swelling; decreased and painful movement; bumps over small joints; and fatigue or fever.

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.