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There are many types of arthritis (disease of the joints). This topic is about rheumatoid arthritis. If you are looking for information about how juvenile idiopathic (rheumatoid) arthritis affects young children, see the topic Juvenile Idiopathic Arthritis. If you are looking for information on the most common form of arthritis in older adults, see the topic Osteoarthritis.
What is rheumatoid arthritis?
Over time, this inflammation may destroy the joint tissues. This can limit your daily activities and make it hard for you to walk and use your hands.
Rheumatoid arthritis is more common in women than in men. It often begins between the ages of 40 and 60.
What causes rheumatoid arthritis?
The exact cause is not known. But rheumatoid arthritis is an autoimmune disease. This means that the body's natural defence system attacks the joints. The disease may run in some families.
What are the symptoms?
The main symptoms of rheumatoid arthritis are pain, stiffness, and swelling in the joints of the hands, wrists, elbows, feet, ankles, knees, or neck. The disease usually affects both sides of the body at the same time. In rare but severe cases, it may affect the eyes, lungs, heart, nerves, or blood vessels.
See a picture of the most commonly affected joints.
Sometimes the disease can cause bumps called nodules to form over the elbows, knuckles, spine, and lower leg bones.
How is rheumatoid arthritis diagnosed?
There is no single test for rheumatoid arthritis. Your doctor will do a physical examination and look at your joints for signs of swelling or tenderness. He or she will also ask about your symptoms and past health.
You may have blood tests, X-rays, and other tests to find out if another problem is causing your joint pain.
How is it treated?
Treatment for rheumatoid arthritis continues throughout your life. It includes medicine, exercise, and lifestyle changes. Getting treatment early may control the condition or keep it from getting worse.
Many of the medicines used to treat rheumatoid arthritis have side effects. So it is important to have regular checkups and talk with your doctor about any problems. This will help your doctor find a treatment that works for you.
At home, there are things you can do to relieve your symptoms.
If you try medicine, exercise, and lifestyle changes for at least a few years but they don't help, surgery may be an option. Total joint replacement of the hip and knee are the most successful.
It can be hard to live with a long-term illness that can limit your ability to do things. It is common for people with rheumatoid arthritis to feel depressed. Your mood can affect how you feel and how well you cope with pain. Be sure to seek the help and support you need from friends and family members. Professional counselling can also help.
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|Arthritis: Managing Rheumatoid Arthritis|
Learning about rheumatoid arthritis:
Living with rheumatoid arthritis:
The cause of rheumatoid arthritis (RA) is not fully understood. 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.
Joint pain can be an early symptom of many different diseases. In rheumatoid arthritis, symptoms often develop slowly over a period of weeks or months. Fatigue and stiffness are usually early symptoms. Weight loss and a low-grade fever can also occur.
Joint symptoms include:
In addition to specific joint symptoms, rheumatoid arthritis can cause symptoms throughout the body (systemic). These include:
Some of the symptoms of rheumatoid arthritis may be similar to symptoms of other health conditions.
The course of rheumatoid arthritis is hard to predict. It usually progresses slowly, over months or years. In some people it doesn't get worse, and symptoms stay about the same. But in rare cases, symptoms come on rapidly, within days.
Symptoms can come and go. You may have times in your life when joint pain goes away on its own for a while. This is called remission.
If the disease progresses, joint pain can restrict simple movements, such as your ability to grip, and daily activities, such as climbing stairs. It is a common cause of permanent disability. But early treatment may control the disease and keep it from getting worse.
Rheumatoid arthritis is more likely to get worse when:
The ongoing inflammation caused by rheumatoid arthritis affects the tissues that line joints. It causes a breakdown in cartilage and loosens ligaments and tendons that support the joints. The resulting joint destruction can lead to deformed joints.
The pain, stiffness, fatigue, and whole-body (systemic) symptoms of rheumatoid arthritis can be disabling. Over time, the deformity caused by the disease can lead to difficulty with daily activities. Specific joint problems may also occur later in the course of the disease.
Hands and wrists are the most common location for deformities. See a picture of the most common problems in the hands.
The feet are also often affected. See a picture of common problems in the feet caused by rheumatoid arthritis.
Inflammation of the knees, if not controlled by treatment, can cause erosion of cartilage and can later lead to the need for knee replacement surgery.
Rheumatoid arthritis can also damage the cervical spine, or neck. This damage can limit how easily you can move your neck. In rare cases, the damage can pinch a nerve or affect the spinal cord and cause numbness, pain, weakness, or paralysis in the arms or legs.
In a small number of severe cases, the disease may damage other organs. It is common for people with rheumatoid arthritis to feel depressed. These feelings may be caused by pain and progressive disability.
Most women with rheumatoid arthritis can become pregnant and have a healthy baby.
The only known risk factor for rheumatoid arthritis is a possible inherited factor in some families (genetic predisposition). A genetic factor may affect how the immune system works. It can cause inflammation and eventual destruction of the membranes that line the joints.
Other factors that may increase your risk for rheumatoid arthritis include:
Call your health professional immediately if you have:
Call your health professional within the next few days if you have:
It is reasonable to try home treatment for mild joint pain and stiffness. If there is no improvement after 6 weeks, or if any other symptoms are present, call your doctor.
Early treatment can slow and sometimes prevent significant joint damage. So if you have symptoms similar to rheumatoid arthritis, see your doctor to find out if you have rheumatoid arthritis. Early diagnosis and treatment allows for possible reduction of joint pain, slows joint destruction, and reduces the chance of permanent disability.
Rheumatoid arthritis can be treated by:
Supportive treatment can be provided by:
No single lab test can diagnose rheumatoid arthritis. Instead, doctors look at symptoms and physical signs and then rule out other diseases that can cause similar symptoms.
A medical history and physical examination are usually done to help find the cause of joint pain. The pattern and nature of joint symptoms are the most important clues to the diagnosis.
Diagnosis is based on a set of classification criteria. The following tests may be done:
Other tests may be done to check for side effects of treatment. These tests may include:
Because rheumatoid arthritis can lead to severe joint destruction and disability over time, regular checkups are important to see if treatment is working or needs to be adjusted.
Rheumatoid arthritis is most often treated with medicine, exercise, and lifestyle changes. Treatment may help relieve symptoms and control the disease, but there is no cure. Treatment for rheumatoid arthritis usually continues throughout your life, but it will vary depending on:
The goal of treatment is to help you maintain your lifestyle, reduce joint pain, slow joint damage, and prevent disability.
Making a plan
Treatment of rheumatoid arthritis should start with education about the disease, the possibility of joint damage and disability, and the risks and benefits of potential treatments. A long-term treatment plan should be developed by you and your team of doctors.
Treatment with medicines
Early and ongoing treatment of RA with medicines called disease-modifying antirheumatic drugs (DMARDs) can slow or sometimes prevent joint destruction.3 Other medicines may be combined with DMARDs to relieve symptoms. These medicines include:
For more information, see Medications.
Treatment for rheumatoid arthritis usually continues throughout your life. Your doctor will want to closely monitor your condition. A rheumatologist should evaluate you regularly. Depending on your symptoms and treatment, this could be done as often as every 2 to 3 months or every 6 to 12 months. Testing, such as blood tests, may be done more often.
During each follow-up visit, your doctor will assess:
In some cases, the disease does not respond to the first several treatments. When this happens, the disease may be treated with much higher doses of medicines or with different combinations of medicines.
Surgery may be considered when the joints—especially the hips, knees, or feet—are severely damaged or deformed and are causing extreme pain. Surgery may include total joint replacement or other techniques to improve joint function. For more information, see Surgery and Other Treatment.
Exercise and lifestyle changes
Exercise, physiotherapy, and lifestyle changes can help relieve joint pain. Many people with RA benefit from self-care plans that balance rest and activity. You can take steps at home to relieve your symptoms and help control your disease. For more information, see Living With Rheumatoid Arthritis.
Living with rheumatoid arthritis often means making changes to your lifestyle. You can do things at home, such as staying active and taking medicines, to help relieve your symptoms and prevent the disease from getting worse. For help managing your disease, see:
You can also plan for those times when the disease symptoms may be more severe. It is important to work closely with your health professionals, who may include a physiotherapist or counsellor, to find ways to reduce pain.
Rest when you're tired
The disease itself causes fatigue. And the strain of dealing with pain and limited activities also can make you tired. The amount of rest you need depends on how bad your symptoms are.
Protect your joints
You may need to change the way you do certain activities so that you are not overusing your joints. Try to find different ways to relieve your joint pain.
Keep moving to maintain muscle strength, flexibility, and overall health.
Eat a balanced diet
Try to eat a healthy, balanced diet. It should be low in saturated fat, cholesterol, and salt and high in fibre and complex carbohydrate (whole grains, beans, fruits, and vegetables). According to some studies, fish oil may improve your symptoms.6
Medicines are the main treatment for rheumatoid arthritis. The types of medicines used depend on how severe your disease is, how fast it is progressing, and how it affects your daily life.
If your symptoms ease, you and your doctor will decide if you can take less medicine or stop taking medicine. If your symptoms get worse, you will have to start taking medicine again.
Medicines are used to:
Medicines called disease-modifying antirheumatic drugs (DMARDs) can slow or sometimes prevent joint destruction. Starting treatment early with DMARDs can reduce the severity of the disease.3 DMARDs are also called immunosuppressive drugs or slow-acting antirheumatic drugs (SAARDs). These medicines work best when taken over a long period to help control the disease.8
DMARDS can be divided into two general categories based on how they work: oral DMARDs and biologic DMARDs. Oral DMARDS are taken by mouth. They interfere with the making or working of immune cells that cause joint inflammation. Biologic DMARDS are given by injection (infusion). They act in several different ways to affect how immune cells work. DMARDs decrease joint inflammation and damage.
Medicines may be given together. This is called combination therapy. Oral medicines are combined with each other or with biologic DMARDs. But biologic DMARDs are not used with each other because of a higher risk of infection. By combining medicines, you may be able to take lower doses of individual medicines. This may reduce your risk of side effects.
Some medicines for rheumatoid arthritis may cause birth defects. If you are pregnant or are trying to become pregnant, talk with your doctor about your medicines.
Medicines to slow the disease
Disease-modifying antirheumatic drugs (DMARDs) are usually started within 3 months of your diagnosis. They are used to control the progression of RA and to try to prevent joint damage and disability. DMARDs are often given in combination with other medicines.
Commonly used oral DMARDs:
Less commonly used oral DMARDs:
Medicines to relieve symptoms
Surgical treatment for rheumatoid arthritis is used to relieve severe pain and improve function of severely deformed joints that don't respond to medication and physiotherapy.
Total joint replacement (arthroplasty) can be done for many different joints in the body. Its success varies depending on which joint is replaced.
Surgeries considered for people who have severe rheumatoid arthritis include:
Joint surgery often restores near-normal movement in a person who has osteoarthritis in just one or two joints. But this is not the case in people affected by rheumatoid arthritis.
Before you decide to have surgery, consult with an orthopedic surgeon who is experienced in joint surgery for rheumatoid arthritis. For more information, see:
Other types of treatment that may help you control some of the symptoms of rheumatoid arthritis include:
Although not proven in scientific studies, complementary therapies are used by many people to relieve symptoms and improve their quality of life. These therapies include:
|Arthritis Society of Canada|
|393 University Avenue|
|Toronto, ON M5G 1E6|
The Arthritis Society provides funding for arthritis research and offers information on patient care, public education, and self-management of arthritis.
|Canadian Rheumatology Association|
|912 Tegal Place|
|Newmarket, ON L3X 1L3|
The Canadian Rheumatology Association is a professional organization of rheumatologists that promotes arthritis care and research in Canada through leadership, education, and communication.
|National Center for Complementary and Alternative Medicine (NCCAM) Clearinghouse|
|P.O. Box 7923|
|Gaithersburg, MD 20898|
(301) 519-3153 for international calls
|Web Address:||www.nccam.nih.gov/health/clearinghouse (or www.nccaminfo.org/livehelp/ for live help online)|
The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information. Send all requests for information and questions about NCCAM to the NCCAM Clearinghouse.
|U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health|
|1 AMS Circle|
|Bethesda, MD 20892-3675|
|Phone:||1-877-22-NIAMS (1-877-226-4267) toll-free|
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research.
The NIAMS website provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.
- O'Dell JR (2005). Rheumatoid arthritis: The clinical picture. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 1165–1194. Philadelphia: Lippincott Williams and Wilkins.
- Harris ED Jr, Firestein GS (2009). Clinical features of rheumatoid arthritis. In GS Firestein et al., eds., Kelley’s Textbook of Rheumatology, 8th ed., vol. 2, pp. 1087–1118. Philadelphia: Saunders Elsevier.
- Kwoh CK, et al. (2002). Guidelines for the management of rheumatoid arthritis. Arthritis and Rheumatism, 46(2): 328–346.
- Häkkinsen A (2004). Effectiveness and safety of strength training in rheumatoid arthritis. Current Opinion in Rheumatology, 16(2): 132–137.
- De Jong Z, et al. (2003). Is a long-term, high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Arthritis and Rheumatism, 48(9): 2415–2424.
- Genovese MC (2009). Treatment of rheumatoid arthritis. In GS Firestein et al., eds., Kelley’s Textbook of Rheumatology, 8th ed., vol. 2, pp. 1119–1143. Philadelphia: Saunders Elsevier.
- Nicola PJ, et al. (2005). The risk of congestive heart failure in rheumatoid arthritis: A population-based study over 46 years. Arthritis and Rheumatism, 52(2): 412–420.
- Verstappen SMM, et al. (2003). Five-year follow-up of rheumatoid arthritis patients after early treatment with disease-modifying antirheumatic drugs versus treatment according to the pyramid approach in the first year. Arthritis and Rheumatism, 48(7): 1797–1807.
- Yocum DE, et al. (2003). Efficacy and safety of tacrolimus in patients with rheumatoid arthritis. Arthritis and Rheumatism, 48(12): 3328–3337.
- Murray MT, Pizzorno JE Jr (2006). Rheumatoid arthritis. In JE Pizzorno, MT Murray, eds., Textbook of Natural Medicine, 3rd ed., vol. 2, pp. 2089–2108. St. Louis: Churchill Livingstone Elsevier.
- Firestein GS (2007). Rheumatoid arthritis. In DC Dale, DD Federman, eds., ACP Medicine, section 15, chap. 2. New York: WebMD.
Other Works Consulted
- Saag KG, et al. (2008). American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis and Rheumatism, 59(6): 762–784.
- Steultjens EEMJ, et al. (2009). Occupational therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews (1).
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Stanford M. Shoor, MD - Rheumatology|
|Last Revised||July 8, 2011|
Last Revised: April 8, 2012
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