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Rheumatoid Arthritis (RA)

Last updated Jan. 14, 2019

Approved by: Maulik P. Purohit MD, MPH

Learn about the causes, symptoms, diagnosis, treatment and pathology of Rheumatoid Arthritis.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Atrophic Arthritis
  • Chronic Rheumatic Arthritis
  • Proliferative Arthritis

What is Rheumatoid Arthritis? (Definition/Background Information)

  • Rheumatoid Arthritis (RA) is a chronic autoimmune systemic inflammatory disorder that affects the lining of joints, surrounding tissues, and organs, within the body (chiefly the hands and feet), of mostly adults
  • Unlike the degeneration of cartilage associated with osteoarthritis, Rheumatoid Arthritis affects the lining of the joint. This causes excessive pain and swelling, resulting in bone erosion and joint deformity
  • Individuals, who develop RA often experience fatigue, stiffness, and joint pain

Who gets Rheumatoid Arthritis? (Age and Sex Distribution)

  • Individuals of all ages, gender, and race/ethnic groups, may develop Rheumatoid Arthritis
  • The signs and symptoms of this joint disorder usually begin to show between the ages of 40 and 60 years
  • Middle-aged women are known to develop this progressive disorder, at a much higher rate than men

What are the Risk Factors for Rheumatoid Arthritis? (Predisposing Factors)

Common risk factors associated with Rheumatoid Arthritis include:

  • Adult women have an increased risk of developing this disorder, than men
  • Individuals in the 40-60 year age group
  • Studies have indicated that Rheumatoid Arthritis is more common in individuals with a certain genetic make-up. Individuals having an immediate family member/relative with a history of RA, have an increased risk of developing the disorder
  • Various studies have found that smoking is a key contributing factor for the development of RA

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Rheumatoid Arthritis? (Etiology)

  • Rheumatoid Arthritis occurs when the body immune system attacks the synovial membranes that surround the joints. The resulting inflammation that occurs due to this abnormal immune response, causes thickening of the synovial membrane (joint linings)
  • Prolonged inflammation may cause damage to the cartilages and bones of the joint. Due to this, the surrounding tendons and ligaments that hold the joint in place are weakened and stretched, slowly causing the joint to lose its alignment and structure
  • Some individuals are more prone to infections than others. Research has shown that this may be due to the presence of certain type of genes in them. Infections with certain viruses and bacteria may trigger the development of Rheumatoid Arthritis
  • Hence, it has been suggested, that individuals with such genes may have a higher risk of developing RA. Research is currently being undertaken to understand better, the genetic risks involved in this autoimmune disorder

What are the Signs and Symptoms of Rheumatoid Arthritis?

Signs and symptoms of Rheumatoid Arthritis, which generally affect multiple joints, include:

  • Noticeable swelling and tenderness of the joints, decreased range of motion
  • Feeling of weakness, loss of weight, ‘feeling sick’
  • Prolonged stiffness of the joints, especially observed in the mornings (that may improve during the day, due to use of the limbs)
  • Firm lumps beneath the skin
  • Elevated body temperatures
  • Joint deformity
  • Common locations of RA manifestation include small joints of the feet, hands, which are affected during early disease stage. As the condition progresses, the larger joints (elbows, knees, hips, shoulders, and ankles) are also affected
  • Often, both the joints (like both the elbows, feet, or wrists) are affected, indicating a symmetrical pattern of the condition
  • Body organs that may be affected are: Skin, lungs, eye, heart, and blood vessels

How is Rheumatoid Arthritis Diagnosed?

Early-stage diagnosis of Rheumatoid Arthritis can sometimes be difficult, often due to the symptoms resembling other conditions. There are a variety of diagnostic tests that a physician may use to diagnose RA, which include:

  • Physical examination: The physician will perform a thorough physical examination to determine, if the individual has RA. In addition to this, a complete medical history may aid in arriving at a definitive diagnosis. The physician will also check the joints for swelling, redness, tenderness, its reflexes, and muscle strength
  • X-rays: X-rays use radiation to produce images of the joints. This can help your physician rule out other possible causes of joint discomfort
  • Blood test: During the blood test, a needle is used to obtain blood samples from an artery or vein, which are then sent to a laboratory for analysis
  • Joint fluid analysis: Occasionally, fluid may accumulate around a joint, resulting in pain and disability. Analysis of such joints may provide evidence regarding the cause of joint fluid accumulation. A needle is inserted into the joint space, and the fluid aspirated with a syringe. The aspirated fluid is sent for a laboratory analysis; the tests a laboratory may perform include:
    • Analyzing what cells are present in the joint fluid
    • Chemical composition of the fluid
    • Examinations of the fluid under a microscope for the presence of crystals
    • If an infection is suspected as the cause for fluid accumulation, then a joint fluid culture may be performed, to remove fluid from the joint
  • General ultrasound imaging: Ultrasounds are high-frequency sound waves that generate a more detailed image of the joint

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Rheumatoid Arthritis?

Complications of Rheumatoid Arthritis could include:

  • Degenerative joint disease, such as osteoporosis
  • A gradual, progressive, and painful condition that affects the hands and arms, which results when the nerves within the wrist, are pinched (carpal tunnel syndrome)
  • Heart disorders due to hardened, obstructed, arteries and inflammation of the synovial membranes of the heart
  • Breathing difficulties due to abnormal inflammation, scarring, of lung tissue
  • Hoarse voice, due to vocal cords being affected
  • Some Rheumatoid Arthritis cases may cause permanent disability

How is Rheumatoid Arthritis Treated?

Currently, the exact underlying cause of Rheumatoid Arthritis is unknown. However, conservative treatments may be used to help reduce pain and improve the range of motion within the joint. These include:

  • Use of specific assistive devices, such as a cane or walker is recommended. This may help individuals perform some of their basic everyday activities
  • Immunosuppressant drugs may be prescribed to control an active immune system
  • Tumor necrosis factor-alpha (TNF-alpha) drugs may be used to block the proteins, responsible for inflammation. These medications can help reduce pain, stiffness in the morning, tenderness or swelling within the joints
  • Several other drugs that may be used to treat RA include anakinra, abatacept, rituximab, and tocilizumab
  • Disease-modifying anti-rheumatic drugs (DMARDs) may be administered to decrease the magnitude of joint damage that could occur
  • Any physical therapy exercises that could aid in strengthening and improving the flexibility of the joints, and also help reduce discomfort. These are generally used, only after the signs and symptoms have been controlled or decreased
  • Non-steroidal anti-inflammatory oral medications, such as ibuprofen and naproxen, may be used to treat Rheumatoid Arthritis. These medications may help decrease the pain and joint swelling
  • Corticosteroid injections help provide temporary relief of symptoms, and in improving the range of motion. It is important to note that corticosteroid injections only give temporary relief. Prolonged episodes of such injections, may injure the joints in the long-run

Surgical treatment measures could include:

  • Arthroscopic chondroplasty: Arthroscopic chondroplasty is a surgical intervention technique that involves repairing the damaged cartilage within the joint; thus allowing the growth of healthy tissue in its place. This surgical procedure is performed using an orthopedic device, called an arthroscope, and is useful in treating mild to moderate Rheumatoid Arthritis
  • Arthroscopic synovectomy: Arthroscopic synovectomy is a minimally invasive surgical procedure that involves a partial or complete removal of the synovial membrane within the joint
  • Bone graft: A bone graft is used to replace damaged or missing bones associated with complex bone fractures
  • Total arthroplasty: Total arthroplasty involves the complete removal of cartilage within a joint. The joint is then removed and replaced by a metal and plastic prosthetic implant. A physician will recommend this surgical procedure, if the inflammatory disorder affects the entire joint
  • Joint fusion: Joint fusion is a surgical technique that involves the removal of the arthritic part within the affected joint, and fusing the surrounding bones together. The purpose of this procedure is to relieve pain, stabilize the joint, and regain some range of motion, within the joint

How can Rheumatoid Arthritis be Prevented?

  • Currently, there are no preventable measures associated with Rheumatoid Arthritis
  • If there is an early, aggressive, and proper treatment of this inflammatory disorder, then the progression of this disabling condition, could be slowed down or decreased

What is the Prognosis of Rheumatoid Arthritis? (Outcomes/Resolutions)

  • The long-term prognosis of Rheumatoid Arthritis depends on the severity of this inflammatory disorder
  • If during the early stages, proper and aggressive treatment of RA is undertaken, then in some patients the condition may show an improvement, without giving rise to any serious complications
  • Other factors that determine the course of outcome of the condition include, if this disorder is in a flared-up state, in an arthritic remission period, or whether it was correctly controlled with treatment
  • A high percentage of individuals, who develop Rheumatoid Arthritis, may experience a lifetime of gradual inflammation, associated with this debilitating disorder

Additional and Relevant Useful Information for Rheumatoid Arthritis:

Juvenile Rheumatoid Arthritis is an auto-immune inflammatory disorder that predominantly affects the hands and feet, of children and adolescents (typically 16 years and younger).

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 28, 2013
Last updated: Jan. 14, 2019